摘要
目的评价术前规律抗血小板聚集治疗对大血管闭塞性急性脑梗死患者机械取栓治疗安全性和有效性的影响。方法回顾性连续纳入2017年3月至2018年9月在首都医科大学宣武医院诊断为前循环颅内大血管闭塞所致急性脑梗死患者,依据术前1周是否规律每天服用阿司匹林75~100 mg或氯吡格雷75 mg,将所有入选患者分为抗血小板聚集治疗组与对照组(未规律服用抗血小板聚集药物治疗)。评价机械取栓前规律服用抗血小板聚集药物对机械取栓治疗后症状性颅内出血发生率、病死率、机械取栓后即刻成功再灌注、术后24 h血管再通和术后3个月患者良好预后的影响。采用多因素Logistic回归分析方法分析术前规律服用抗血小板聚集药物对术后血管成功再灌注的影响。结果共192例患者纳入统计分析,其中54例(28.1%)患者在机械取栓前规律服用抗血小板聚集药物治疗。抗血小板聚集治疗组中,6例(11.1%)患者术后出现了症状性颅内出血,138例对照组患者中,18例(13.0%)患者术后出现了症状性颅内出血,两组间症状性颅内出血发生率差异无统计学意义(χ^(2)=0.13,P=0.72)。抗血小板聚集治疗组患者的病死率为18.5%(10例),对照组为17.3%(24例),两组间病死率差异无统计学意义(χ^(2)=0.03,P=0.85)。两组间的术后24 h血管再通率和术后3个月良好预后比例差异均无统计学意义(均P>0.05)。抗血小板聚集治疗组患者机械取栓后即刻成功再灌注的比例明显高于对照组[94.4%(51/54)比81.2%(112/138);χ^(2)=5.34,P=0.02]。多因素Logistic回归分析结果显示,术前规律服用抗血小板聚集药物是机械取栓后即刻成功再灌注的保护性因素(OR=3.31,95%CI:1.13~10.62,P=0.03)。结论机械取栓前规律抗血小板聚集治疗不增加大血管闭塞脑梗死患者机械取栓治疗后的症状性颅内出血发生率和病死率。机械取栓治疗前规律抗血小板聚集治疗的患者有�
Objective To evaluate the association of pretreatment antiplatelet therapy with safety and efficacy outcomes following mechanical thrombectomy for emergent large vessel occlusion.Methods Patients with acute ischemic stroke caused by anterior circulation emergent large vessel occlusion,which was diagnosed in Xuanwu Hospital,Capital Medical University from March 2017 to September 2018 were retrospectively included.According to whether regularly taking Aspirin 75-100 mg or clopidogrel 75 mg per day one week before operation,all patients were divided into the antiplatelet treatment group and the control group(without regular antiplatelet treatment).The effects of regular antiplatelet therapy before mechanical thrombectomy on the incidence of symptomatic cerebral hemorrhage,mortality,the proportion of successful reperfusion after mechanical thrombectomy,the proportion of vessel recanalization 24 hours after operation,and the functional outcome at 3 months were evaluated.Multivariate Logistic regression analysis was used to analyze the effect of regular antiplatelet therapy on successful reperfusion after thrombectomy.Results A total of 192 patients were final included in the statistical analysis.Among them,54 patients(28.1%)regularly took antiplatelet drugs before mechanical thrombectomy.Symptomatic cerebral hemorrhage occurred in 6 patients(11.1%)in the antiplatelet treatment group and 18 patients(13.0%)in the control group.There was no significant difference between the two groups(χ^(2)=0.13,P=0.72).The mortality in the antiplatelet treatment group was 18.5%(10 cases)and 17.3%(24 cases)in the control group.There was no significant difference between the two groups(χ^(2)=0.03,P=0.85).There was no significant difference between the two groups in the rate of vascular recanalization 24 h after operation and the proportion of good prognosis 3 months after operation(both P>0.05).The percentage of successful reperfusion in the antiplatelet treatment group was significantly higher than that in the control group(94.4%[51/5
作者
吴川杰
吴隆飞
孙程贺
吉康祥
马青峰
宋海庆
焦力群
吉训明
Wu Chuanjie;Wu Longfei;Sun Chenghe;Ji Kangxiang;Ma Qingfeng;Song Haiqing;Jiao Liqun;Ji Xunming(Department of Neurology,Xuanwu Hospital,Capital Medical Univeristy,Beijing 100053,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2022年第5期299-305,338,共8页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金(82071468)
国家重点研发计划(2016YFC1301502)。
关键词
机械取栓
抗血小板聚集
阿司匹林
氯吡格雷
Mechanical thrombectomy
Antiplatelet therapy
Aspirin
Clopidogrel
