基于血栓弹力图抗栓治疗动脉粥样硬化性脑梗死的疗效分析*

Effect of TEG-based antithrombotic therapy on neurological recovery in patients with acute atherosclerotic cerebral infarction*

摘要:

目的 探讨基于血栓弹力图（TEG）抗栓治疗急性动脉粥样硬化性脑梗死的疗效。方法 选取连云港市第二人民医院收治的184例急性动脉粥样硬化性脑梗死（ACI）患者。随机分为：A组，阿司匹林抗栓治疗；B组，氯吡格雷抗栓治疗；C组，氯吡格雷联合阿司匹林抗栓治疗；D组，用血栓弹力图仪检测血小板抑制率，选择血小板抑制率高的抗栓药物治疗，每组46例。比较患者治疗前后神经功能缺损评分（NIHSS）、日常生活能力评分（ADL）、微栓子（MES）阳性率改善情况，统计卒中复发率及出血性事件的发生率。结果 治疗后4组患者的NIHSS评分下降，而ADL评分提高（P?<0.05），且治疗后C、D组NIHSS评分低于A、B组，ADL评分高于A、B组（P?<0.05）。治疗后，C、D两组临床治疗有效率高于A组（P?<0.0167）。治疗后，4组患者的MES阳性率均降低（P?<0.05），且C组MES阳性率均低于A、B组（P?< 0.0167）。4组胃肠道不适、病死率比较，差异无统计学意义（P?>0.05）；治疗后C、D两组复发率低于A组（P?<0.0167），但C、D两组间比较，差异无统计学意义（P?>0.05）。出血事件B、D两组低于C组（P?<0.0167）。结论 采用基于血栓弹力图个体化治疗ACI的抗栓效果优于阿司匹林和氯吡格雷单用，同时能够有效降低双抗药物联合治疗带来的出血性事件风险。

Abstract:

Objective To analyze the effect of TEG based antithrombotic therapy on neurological recovery in patients with acute atherosclerotic cerebral infarction (ACI). Methods Totally 184 patients with ACI in our hospital were involved in this study. Patients received aspirin (group A), clopidogrel (group B) or clopidogrel plus aspirin (group C) 46 cases for each group. Choice of anti-platelet therapy in group D were determined by TEG (n?=?46). NIHSS score, ADL score, the positive rate of MES, the incidence of stroke recurrence rate and the rate of hemorrhagic events before and after treatment were recorded. Results Anti-platelet therapy induced a significant decrease of NIHSS score as well as MES positive rate and increase of ADL score in four groups when compared with those prior to any treatments (P??0.05). Effective rate in C and D group were significantly higher while recurrence rate was lower than those in group A and B (P? 0.05). There was no statistically significant difference in gastrointestinal discomfort and mortality among the four groups (P?>?0.05). The incidence of bleeding events in group B and D were significantly lower than group C (P?< 0.0167). Conclusions Personized anti-platelet therapy based on TEG is more efficient with less bleeding events in the treatment of the patients with ACI.