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目的探讨拜阿司匹林在硬脑脑膜颞浅动脉血管融通术(EDAS)术后预防脑梗死发生的作用。方法收集2012年9月至2014年5月在国内多家三级甲等医院(新疆医科大学第二附属医院、新疆医科大学第一附属医院、新疆维吾尔自治区人民医院,潍坊市人民医院、聊城市中心医院、青岛医科大学附属医院、日照人民医院)收住的明确诊断为烟雾病,并接受EDAS术的患者。根据术后是否应用拜阿司匹林预防脑梗死,将患者分为阿司匹林组(78例)和非阿司匹林组(97例)。术后3、7、30、90 d例行复查头颅磁共振成像观察脑梗死发生情况。收集具有完整术后3、7、30、90 d磁共振成像复查结果的病例统计脑梗死发生情况,回顾性研究拜阿司匹林在EDAS术后预防脑梗死的作用。结果阿司匹林组术后脑出血4例(5.1%),脑梗死6例(7.7%);非阿司匹林组脑出血1例(1.0%),脑梗死19例(19.6%)。阿司匹林组脑梗死的发生率显著低于非阿司匹林组(P<0.05),两组脑出血发生率差异无统计学意义(P>0.05)。结论拜阿司匹林在EDAS术后能有效地降低脑梗死发生的风险,尤其是后循环供血区明显,但一定程度上也加重了脑出血发生的风险。
Objective To investigate the effect of aspirin on the prevention of cerebral infarction after epidural arterial vascular bypass (EDAS). Methods From September 2012 to May 2014, many Grade A hospitals in China (Second Affiliated Hospital of Xinjiang Medical University, First Affiliated Hospital of Xinjiang Medical University, People’s Hospital of Xinjiang Uygur Autonomous Region, People’s Hospital of Weifang City, Liaocheng Central Hospital, Qingdao Medical University Hospital, Rizhao People’s Hospital) admitted to the clear diagnosis of moyamoya disease, and patients undergoing EDAS surgery. Patients were divided into aspirin group (n = 78) and non-aspirin group (n = 97) according to whether postoperative aspirin was used to prevent cerebral infarction. Postoperative 3,7,30,90 d routine review of head magnetic resonance imaging to observe the occurrence of cerebral infarction. The complete cerebral infarction was collected at 3, 7, 30, and 90 days after magnetic resonance imaging. The effect of aspirin on preventing cerebral infarction after EDAS was retrospectively studied. Results There were 4 cases (5.1%) of cerebral hemorrhage in the aspirin group and 6 cases (7.7%) of cerebral infarction. One case (1.0%) of cerebral hemorrhage and 19 cases (19.6%) of cerebral infarction in non-aspirin group. The incidence of cerebral infarction in aspirin group was significantly lower than that in non-aspirin group (P <0.05). There was no significant difference in the incidence of cerebral hemorrhage between two groups (P> 0.05). Conclusion Aspirin can effectively reduce the risk of cerebral infarction after EDAS, especially the obvious blood supply of posterior circulation, but it also aggravates the risk of cerebral hemorrhage to a certain extent.