氯吡格雷对老年短暂性脑缺血发作合并意识障碍患者的治疗效果
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摘要
目的探讨氯吡格雷对老年短暂性脑缺血发作合并意识障碍患者的治疗效果。方法选取2012年6月-2017年6月在辽河油田总医院老年病科接受诊治的老年短暂性脑缺血合并意识障碍患者60例。根据随机数字表法分为两组,每组30例。对照组采用盐酸倍他汀片+阿司匹林的常规治疗,观察组在对照组的基础上给予氯吡格雷治疗,均持续治疗3个月。比较两组治疗后临床疗效、凝血指标及血脂水平[包括总胆固醇(TC),甘油三酯(TG)及低密度脂蛋白胆固醇(LDL-C)];随访12～48个月,观察两组脑卒中发病情况。结果观察组临床总有效率为96.67%,明显高于对照组的76.67%(χ~2=5.192,P<0.05)。与治疗前相比,两组治疗后APTT、PT明显延长,FIB水平明显下降,且观察组明显优于对照组(P<0.05);两组治疗后GCS评分显著上升,且观察组高于对照组(P<0.05)。与治疗前相比,两组治疗后TC、TG、LDL-C水平均显著下降,且观察组显著低于对照组(P<0.05)。两组治疗后均随访12～48个月,随访期间对照组中有5例(16.67%)出现脑卒中,而观察组中暂无脑卒中病例,观察组预后明显优于对照组(P<0.05);随访期间两组均未出现死亡病例。结论氯吡格雷对老年短暂性缺血合并意识障碍的治疗效果显著,可以降低血脂,有效改善患者的凝血功能及意识状态。
Objective To investigate the clinical efficacy of clopidogrel in elderly patients with transient ischemic attack and consciousness disturbance. Methods Sixty elderly patients with transient cerebral ischemia concomitant with consciousness disturbance treated in the Department of Geriatrics of Liaohe Oilfield General Hospital between June 2012 and June 2017 were selected as the subjects,who were divided into two groups using random number table method,with 30 cases in each group. The control group was given betastatin hydrochloride tablets as routine treatment,while the observation group was additionally given clopidogrel. After treatment of 3 months,the clinical efficacy,coagulation indexes,and levels of total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C) were compared between the two groups. Follow-up lasted 12 to 48 months,and the incidence of stroke in the two groups was observed. Results The total clinical effective rate in the observation group was 96.67%,which was significantly higher than that of the control group(76.67%,χ~2= 5.192,P<0.05). After treatment,APTT and PT were significantly prolonged,while FIB was significantly decreased,especially in the observation group(P<0.05).The GCS scores in the two groups were increased significantly after treatment,especially in the observation group(P<0.05). After treatment,the levels of TC,TG and LDL-C decreased significantly in the two groups,particularly in the observation group(P<0.05). During the follow-up,5 cases(16.67%) in the control group had stroke,but no stroke occurred in the observation group. The prognosis of the observation group was significantly better than that of the control group(P<0.05),and there was no case of death in either group during the follow-up. Conclusion Clopidogrel is effective for senile transient ischemia with consciousness disturbance by decreasing blood lipids and effectively improving the coagulation function and consciousness state.
Objective To investigate the clinical efficacy of clopidogrel in elderly patients with transient ischemic attack and consciousness disturbance. Methods Sixty elderly patients with transient cerebral ischemia concomitant with consciousness disturbance treated in the Department of Geriatrics of Liaohe Oilfield General Hospital between June 2012 and June 2017 were selected as the subjects,who were divided into two groups using random number table method,with 30 cases in each group. The control group was given betastatin hydrochloride tablets as routine treatment,while the observation group was additionally given clopidogrel. After treatment of 3 months,the clinical efficacy,coagulation indexes,and levels of total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C) were compared between the two groups. Follow-up lasted 12 to 48 months,and the incidence of stroke in the two groups was observed. Results The total clinical effective rate in the observation group was 96.67%,which was significantly higher than that of the control group(76.67%,χ~2= 5.192,P<0.05). After treatment,APTT and PT were significantly prolonged,while FIB was significantly decreased,especially in the observation group(P<0.05).The GCS scores in the two groups were increased significantly after treatment,especially in the observation group(P<0.05). After treatment,the levels of TC,TG and LDL-C decreased significantly in the two groups,particularly in the observation group(P<0.05). During the follow-up,5 cases(16.67%) in the control group had stroke,but no stroke occurred in the observation group. The prognosis of the observation group was significantly better than that of the control group(P<0.05),and there was no case of death in either group during the follow-up. Conclusion Clopidogrel is effective for senile transient ischemia with consciousness disturbance by decreasing blood lipids and effectively improving the coagulation function and consciousness state.
引文
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[12]王俊萍,孙利海.阿司匹林联合氯吡格雷对短暂性脑缺血发作患者血小板功能及复发的影响[J].医药,2017,67(1):142.
[13]LI Z,WANG Y,ZHAO X,et al.Treatment effect of clopidogrel plus aspirin within 12 hours of acute minor stroke or transient ischemic attack[J].J Am Heart Assoc,2016,5(3):e003038.
[14]张成刚,孙中武.阿托伐他汀钙联合氯吡格雷预防老年短暂性脑缺血发作患者脑梗死的效果及对血脂、血小板的影响[J].中国老年学,2016,36(19):4759.
[2]HUANG H L,WANG N,ZHOU H,et al.Study on influence of transient ischemic attack on subsequent cerebral infarction[J].Eur Rev Med Pharmacol Sci,2016,20(24):5164.
[3]杨春丽,王兰桂.老年短暂性脑缺血发作危险因素及合并颈动脉粥样硬化斑块的特点[J].中国老年学杂志,2016,36(14):3448.
[4]BEJOT Y,DAUBAIL B,GIROUD M.Epidemiology of stroke and transient ischemic attacks:Current knowledge and perspectives[J].Revue Neurologique,2016,172(1):59.
[5]陈哲,刘竟芳,杨非柯,等.以意识障碍为主要表现的老年人短暂性脑缺血发作1例报告[J].实用老年医学,2018(1):92.
[6]石庆轩.脑血管狭窄因素致短暂性脑缺血发作患者的临床表现分析[J].世界最新医学信息文摘,2016,16(62):76.
[7]余爱勇,赵迎春.低血糖脑病和短暂性脑缺血发作的临床和影像特征分析[J].国际神经病学神经外科学杂志,2018,45(1):74.
[8]ROTHWELL P M,ALGRA A,CHEN Z,et al.Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke:time-course analysis of randomised trials[J].Lancet,2016,388(10042):365.
[9]常青,薛茜,张耀元,等.氯吡格雷联合阿司匹林序贯疗法治疗老年短暂性脑缺血发作的效果及对血清血管内皮生长因子、基质金属蛋白酶-9、血管紧张素-Ⅱ水平的影响[J].中国老年学杂志,2018,38(3):524.
[10]HIATT W R,FOWKES F G,HEIZER G,et al.Ticagrelor versus clopidogrel in symptomatic peripheral artery disease[J].N Engl J Med,2017,376(1):32.
[11]赵刚峡,王水平.氯吡格雷联合阿司匹林对老年短暂性脑缺血发作的临床疗效分析[J].中国实用神经疾病杂志,2017,20(20):38.
[12]王俊萍,孙利海.阿司匹林联合氯吡格雷对短暂性脑缺血发作患者血小板功能及复发的影响[J].医药,2017,67(1):142.
[13]LI Z,WANG Y,ZHAO X,et al.Treatment effect of clopidogrel plus aspirin within 12 hours of acute minor stroke or transient ischemic attack[J].J Am Heart Assoc,2016,5(3):e003038.
[14]张成刚,孙中武.阿托伐他汀钙联合氯吡格雷预防老年短暂性脑缺血发作患者脑梗死的效果及对血脂、血小板的影响[J].中国老年学,2016,36(19):4759.
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