阿托伐他汀对合并颈动脉不稳定斑块骨折患者围术期缺血性脑卒中的效果

摘要

目的 探讨阿托伐他汀治疗合并颈动脉不稳定斑块骨折患者围术期缺血性脑卒中的临床效果.方法 选择2015年1月～2017年1月重庆市江津区中心医院收治的围术期发生缺血性脑卒中的合并颈动脉不稳定斑块的骨折患者86例,根据治疗方案分为研究组(43例)和对照组(43例).两组患者均给予抗凝、改善微循环、保护神经功能等常规治疗,研究组患者在常规治疗的基础上联合阿托伐他汀治疗,所有患者均连续治疗6个月.检测治疗前后两组患者的总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等血脂指标以及颈动脉内膜中层厚度(IMT)、颈动脉斑块情况.采用神经功能缺损评分(NIHSS)对患者的神经功能损伤情况进行评价.同时对比两组患者治疗过程中的短暂性脑缺血发作(TIA)、脑卒中复发情况以及不良反应发生情况.结果 研究组治疗后的TC、TG及LDL-C的水平及IMT、斑块最大直径、斑块面积、NIHSS评分低于对照组,HDL-C水平高于对照组,差异均有统计学意义(P＜0.05).研究组TIA发生率及缺血性脑卒中复发率均低于对照组(P＜0.05),但两组不良反应发生率比较差异无统计学意义(P＞0.05).结论 阿托伐他汀治疗合并颈动脉不稳定斑块骨折患者围术期缺血性脑卒中的效果显著.它能够明显改善患者的血脂水平及颈动脉不稳定斑块状态,同时促进神经功能恢复,降低脑血管缺血事件的发生率,具有一定的安全性,值得临床推广.%Objective To investigate the clinical effect of Atorvastatin in the treatment of fracture patients with unstable carotid plaque occurred ischemic stroke in perioperative.Methods From January 2015 to January 2017,86 fracture patients combined with carotid artery plaques occurred ischemic stroke in perioperative in Jiangjin District Central Hospital were selected.They were divided into study group (43 cases) and observation group (43 cases) according to the therapeutic schedule.They were treated by the routine treatment,such as anticoagulation,improved microcirculation and neuroprotective function,and the patients in the study group were treated with Atorvastatin based on those treatments.All the patients were treated for 6 months.Before and after treatment,the levels of total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C),carotid intima-media thickness (IMT) and carotid artery plaque were detected.The nerve function damage of patients was evaluated by neurological deficit score (NIHSS).Then the transient ischemic attack (TIA),recurrent stroke and adverse reactions of the two groups were compared.Results Mter treatment,the levels of TC,TG,LDL-C,IMT,maximum diameter,plaque area,and NIHSS scores in the study group were lower than those in the control group,while the level of HDL-C was higher than that in control group,with statistically significant difference (P ＜ 0.05).The incidence of TIA and ischemic stroke recur rence rate in the study group were lower than those in the control group (P ＜ 0.05).However,there was no significant dif ference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion The effect of Atorvastatin in fracture patients combined with carotid artery plaques occurred ischemic stroke in perioperative is significant.Atorvastatin can obviously improve the patient's blood lipid levels and carotid artery plaque instability state,promote nerve functional recovery,reduce the incidence of cerebral ischemic events,and has a certain safety,so it is worthy of clinical application.