静脉溶栓治疗后不同抗血小板治疗时机对急性缺血性卒中患者凝血功能及预后影响的对比研究

摘要

目的 比较静脉溶栓治疗后不同抗血小板治疗时机对急性缺血性卒中患者凝血功能及预后的影响.方法 选取2014年5月—2016年5月老河口市一医院神经内科诊治的急性缺血性卒中患者100例,随机分为早期组和晚期组,每组50例.两组患者均给予阿替普酶静脉溶栓治疗,早期组患者在溶栓治疗后24 h内给予阿司匹林抗血小板治疗,晚期组患者在溶栓治疗后24 h后给予阿司匹林抗血小板治疗.比较两组患者入院时血脂指标、空腹血糖(FBG)、同型半胱氨酸(Hcy)水平,溶栓后1 d血管再闭塞发生率和溶栓后3 d颅内出血发生率,溶栓前及溶栓后3 d、7 d凝血功能指标,溶栓前及溶栓后3个月、6个月、12个月美国国立卫生研究院卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分.结果 两组患者入院时三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、FBG、Hcy水平比较,差异无统计学意义(P>0.05).两组患者溶栓后1 d血管再闭塞发生率和溶栓后3 d颅内出血发生率比较,差异无统计学意义(P>0.05).两组患者溶栓前和溶栓后7 d 血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、凝血活酶时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)及溶栓后3 d PLT、MPV、PDW、D-D比较,差异均无统计学意义(P>0.05);早期组患者溶栓后3 d PT、APTT、TT长于晚期组,FIB低于晚期组(P<0.05).两组患者溶栓前及溶栓后3个月、6个月、12个月NIHSS评分和mRS评分比较,差异均无统计学意义(P>0.05).结论 与溶栓治疗后24 h后给予抗血小板治疗相比,溶栓治疗后24 h内给予抗血小板治疗对急性缺血性卒中患者预后无明显影响,反之可能会增加出血风险.%Objective To compare the impact of different anti-platelet therapy opportunities after intravenous thrombolysis on coagulation function and prognosis in patients with acute ischemic stroke.Methods From May 2014 to May 2016,a total of 100 patients with acute ischemic stroke were selected in the Department of Neurology,the First Hospital of Laohekou,and they were randomly divided into A group and B group,each of 50 cases.Based on intravenous thrombolysis of rt-PA,patients in A group received anti-platelet therapy of aspirin within 24 hours after intravenous thrombolysis,while patients in B group received anti-platelet therapy of aspirin over 24 hours after intravenous thrombolysis.Observation index was compared between the two groups,including blood lipids index,FBG and Hcy at admission,incidence of vascular reocclusion 1 day after intravenous thrombolysis and intracranial hemorrhage 3 days after intravenous thrombolysis,index of coagulation function before intravenous thrombolysis,3 days and 7 days after intravenous thrombolysis,NIHSS score and mRS score before intravenous thrombolysis,3 months,6 months and 12 months after intravenous thrombolysis.Results No statistically significant differences of TG,TC,LDL-C,HDL-C,FBG or Hcy was found between the two groups at admission(P>0.05),nor was incidence of vascular reocclusion 1 day after intravenous thrombolysis or intracranial hemorrhage 3 days after intravenous thrombolysis (P>0.05).No statistically significant differences of PLT,MPV,PDW,PT,APTT,TT,FIB or D-dimer was found between the two groups before intravenous thrombolysis or 7 days after intravenous thrombolysis,nor was PLT,MPV,PDW or D-dimer 3 days after intravenous thrombolysis(P>0.05);3 days after intravenous thrombolysis,PT,APTT and TT in A group were statistically significantly longer than those in B group,while FIB in A group was statistically significantly lower than that in B group(P<0.05).No statistically significant differences of NIHSS score or mRS score was found between the two groups before intravenous thrombolysis,3 months,6 months or 12 months after intravenous thrombolysis(P>0.05).Conclusion Compared with anti-platelet therapy over 24 hours after intravenous thrombolysis,anti-platelet therapy within 24 hours after intravenous thrombolysis has no obvious impact on prognosis in patients with acute ischemic stroke,whereas it may increase the risk of hemorrhage.