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目的观察阿司匹林联合氯吡格雷治疗进展性脑梗死的临床疗效。方法选取2011年6月—2014年6月安康市中心医院神经内科收治的进展性脑梗死患者100例。采用随机数字表法将患者分为观察组和对照组,各50例。对照组患者单纯实施阿司匹林药物治疗,观察组患者在对照组基础上联合使用氯吡格雷药物治疗。比较两组患者治疗前后血清高敏C反应蛋白(hs-CRP)水平、神经功能指标、血液流变学指标及不良反应和预后情况。结果两组患者治疗前血清hs-CRP水平比较,差异无统计学意义(P>0.05);观察组患者治疗后7、14 d血清hs-CRP水平均低于对照组(P<0.05)。两组患者治疗前美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(P>0.05);观察组患者治疗后14、30、90 d NIHSS评分均低于对照组,治疗后14、30、90 d Barthel指数均高于对照组,治疗后90 d mRS指数低于对照组(P<0.05)。两组患者治疗前纤维蛋白原、血小板聚集率、血浆黏度和全血低切黏度比较,差异均无统计学意义(P>0.05);观察组患者治疗后1年纤维蛋白原、血小板聚集率、血浆黏度和全血低切黏度均低于对照组(P<0.05)。两组治疗期间并发症发生率及随访1年中缺血性脑卒中或短暂性脑缺血(TIA)再发率、脑出血发生率比较,差异均无统计学意义(P>0.05)。结论阿司匹林联合氯吡格雷治疗进展性脑梗死临床疗效较好,可有效促进患者神经功能恢复和抑制血栓形成,改善患者预后。
Objective To observe the clinical efficacy of aspirin plus clopidogrel in the treatment of patients with progressive cerebral infarction. Methods One hundred patients with progressive cerebral infarction admitted from June 2011 to June 2014 in Ankang Central Hospital were enrolled. The patients were divided into observation group and control group by random number table method, each 50 cases. Patients in the control group were treated with aspirin only, while patients in the observation group were treated with clopidogrel in combination with the control group. Serum high-sensitivity C-reactive protein (hs-CRP) levels, neurological function, hemorheological parameters, adverse reactions and prognosis were compared between the two groups before and after treatment. Results There was no significant difference in serum hs-CRP level between the two groups before treatment (P> 0.05). The serum hs-CRP level of the observation group was lower than that of the control group on the 7th and 14th day after treatment (P <0.05). There was no significant difference in NIHSS scores between the two groups before treatment (P> 0.05). The NIHSS scores of the observation group were lower than those of the control group at 14, 30 and 90 days after treatment The Barthel index at 14th, 30th and 90th days after treatment was higher than that of the control group. The mRS index at 90 days after treatment was lower than that of the control group (P <0.05). There was no significant difference in fibrinogen, platelet aggregation rate, plasma viscosity and whole blood low-shear viscosity between the two groups before treatment (P> 0.05). The fibrinogen, platelet aggregation rate, Plasma viscosity and whole blood low shear viscosity were lower than the control group (P <0.05). There was no significant difference in the complication rates between the two groups and the incidence of ischemic stroke or transient ischemic reperfusion (TIA) and cerebral hemorrhage at one year follow-up (P> 0.05). Conclusion Aspirin combined with clopidogrel in the treatment of advanced cerebral infarction has a good clinical efficacy, which can effectively promote the recovery of neurological function, inhibit the thrombosis and improve the prognosis of patients.