彭慕立+苏赤+肖彧+林培坚+陈峰+彭秉纲+梁国华

[摘要] 目的 分析阿司匹林联合氯吡格雷治疗大脑中动脉狭窄脑梗死的临床效果及用药安全性。 方法 将本院神经内科收治的90例急性大脑中动脉狭窄脑梗死患者根据入院顺序随机分为对照组和治疗组，每组各45例，其中对照组口服阿司匹林，治疗组在对照组治疗方案的基础上加用氯吡格雷，均以2个月为1个疗程，1个疗程结束后比较两组患者改良Fugl-Meyer上肢体综合功能评分、改良Barthel指数评分以及脑梗死进展率、复发率。 结果 两组患者VAS、Fugl-Meyer、Barthel指数评分比较，差异有统计学意义（P<0.05），治疗组优于对照组；治疗组脑梗死进展率、复发率低于对照组（P<0.05）。 结论 阿司匹林联合氯吡格雷治疗急性大脑中动脉狭窄脑梗死的效果明显，可提高患者的生活质量，缩短患者重返社会的时间。

[关键词] 大脑中动脉狭窄脑梗死；阿司匹林；氯吡格雷

[中图分类号] R743[文献标识码] A[文章编号] 1674-4721（2014）03（c）-0080-03

Clinical research of aspirin combined with clopidogrel in the cerebral infarction of middle cerebral artery stenosis

PENG Mu-li SU Chi XIAO Yu LIN Pei-jian CHEN Feng PENG Bing-gang LIANG Guo-hua

Neurology Department,People′s Hospital of Gaoyao City in Guangdong Province,Gaoyao 526040,China

[Abstract] Objective To analyze the clinical curative effect and drug safety of aspirin combined with clopidogrel in the cerebral infarction of middle cerebral artery stenosis. Methods 90 patients with cerebral infarction of acute middle cerebral artery stenosis who received and cured of neurology department in our hospital were randomly divided into control group and treatment group according to admission order,45 cases in each group.The control group had oral aspirin therapy,the treatment group plus clopidogrel on the basis of the control group,all the patients had 4 weeks for a period of treatment,then compared modified Fugl-Meyer comprehensive function score,modified Barthel index score and the cerebral infarction progress rates and recurrence rates of the two groups of patients after the treatment. Results The VAS,Fugl-Meyer,Barthel index score were statistical differently between the two groups of patients (P<0.05),treatment group was superior to control group.Cerebral infarction recurrence rate and progress rates of treatment group were lower than those of the control group (P<0.05). Conclusion Aspirin combined with clopidogrel had significant curative effect in the cerebral infarction of acute middle cerebral artery stenosis,can ideally improve the patients′ quality of life,shorten the time of the patients return to society.

[Key words] Cerebral infarction of middle cerebral artery stenosis;Aspirin;Clopidogrel

运动功能障碍是脑梗死后最常见的并发症之一[1]，超过80%的脑梗死偏瘫患者存在不同程度的运动功能障碍，运动功能障碍导致患者肢体肌肉主动活动减少，患者无法集中精力学习新技能，延长了患者的治疗时间，阻碍整体康复进程，从而影响脑卒中患者的生活质量。

阿司匹林是急性期脑梗死的处理首选药物，起效迅速，二级预防方案中认为根据循证医学的证据级别（Ⅰ级），阿司匹林和氯吡格雷是首选单药治疗的药物，氯吡格雷疗效好于阿司匹林[1]。但是大多数文献中的样本包括所有分型的脑卒中患者作为研究对象的随机对照实验，并非针对大脑中动脉狭窄的治疗研究。本研究回顾性分析本院收治的90例大脑中动脉狭窄脑梗死患者的临床资料，以探讨阿司匹林联合氯吡格雷治疗急性大脑中动脉狭窄脑梗死的临床疗效。……