1例有出血风险的高血压患者致缺血性脑卒中的循证预防研究

摘要

Objective:To formulate a individulized secondary prevention program for a patient with ischemic stroke companing with risk of bleeding,through searching literature and collecting clinical evidence.Methods:After asking medical history carefully and reevaluating the patient's condition,we searched articles from Cochrane library(1991-2015),Embase (1991-2015),Medline (1946-2015)、WeiPu(1991-2015)、CBM(1990-2013),Uptodate and Best Evidence.Then,we made a individualized,reasonable and effective prevention program after communicating with the patient and his family members.Results:11 articles had been included, which involving whether hepertension increases the incidence of recurrence of ischemic stroke and effectiveness and safety of antiplatelet drugs used to prevent recurrence of ischemic stroke.Moreover,after communicating with the patient,we had prescribed the prevention program,which including blood pressure lowering,life style optimizing and clopidogrel to antiplatelet.Conclusion:Formulating the individualized secondary prevention for ischemic stroke based on evidence,not only increases the coherence of patients and effectiveness,but also promotes the mutu-trust between doctors and patients.%目的:针对1例服用阿司匹林有出血风险的高血压病人所致缺血性脑卒中患者,采用循证医学方法,检索临床文献证据,为患者制定个体化的二级预防方案.方法:对2015年4月10日在本院就诊的服用阿司匹林有便血史的缺血性脑卒中患者,在充分询问并评估患者状态后,从Cochrane library(1991-2015年)、Embase (1991-2015年)、Medline (1946-2015年)、维普(1991-2015年)、中国生物医学文献系统(CBM)(1990-2013年)、Uptodate、Best Evidence中检索文献,提取临床证据.并与患者及家属沟通,为患者制定一个合理、有效且依从性好的预防方案.结果:共纳入11篇文献.内容包含高血压病是否增加缺血性脑卒中复发的风险?和抗血小板聚集对缺血性脑卒中复发的预防作用的有效性和安全性比较.根据上述证据并结合患者意愿,给予了控制血压、改善生活方式及氯吡格雷抗血小板治疗预防缺血性脑卒中的复发.结论:采用循证医学方法为有出血风险的的高血压患者制定的个体化的预防缺血性脑卒中复发方案,不仅增加了患者的依从性,取得了良好的疗效且增加了医生与患者之间的互信.