方明

[摘要]目的 探討氯吡格雷联合低分子肝素钙治疗进展性缺血性脑卒中的有效性及安全性。方法 选取2014年3月～2016年12月在我院接受治疗的96例进展性缺血性脑卒中患者为研究对象，采用随机数字法分为观察组和对照组，各48例，对照组采用低分子肝素钙治疗，观察组在对照组基础上使用氯吡格雷，比较两组的疗效、治疗前后神经功能缺损评分（NIHSS）及患者血浆黏度、纤维蛋白原、血小板聚集率等血流动力学指标变化，观察不良反应。结果 观察组的总有效率为93.75%，显著高于对照组的79.17%，差异有统计学意义（P<0.05）；治疗后，观察组的NIHSS评分显著低于对照组，差异有统计学意义（P<0.05）；血流动力学方面，观察组治疗后的血浆黏度、纤维蛋白原、血小板聚集率等指标均显著优于对照组，差异有统计学意义（P<0.05）；两组患者治疗后的总不良反应发生率比较，差异无统计学意义（P>0.05）。结论 氯吡格雷联合低分子肝素钙治疗进展性缺血性脑卒中的效果明显，安全性高，临床上具有较高的应用价值。

[关键词]氯吡格雷；低分子肝素钙；进展性缺血性脑卒中；有效性；安全性

[中图分类号] R743.3 [文献标识码] A [文章编号] 1674-4721（2017）04（b）-0134-03

The efficacy and safety of Clopidogrel combined with Low Molecular Weight Heparin Calcium in the treatment of progressive ischemic stroke

FANG Ming

Department of Internal Neurology，the Third Hospital of Nanchang City in Jiangxi Province，Nanchang 330009，China

[Abstract]Objective To investigate the efficacy and safety of Clopidogrel combined with Low Molecular Weight Heparin Calcium in the treatment of progressive ischemic stroke.Methods 96 patients with progressive ischemic stroke who were treated in our hospital from March 2014 to December 2016 were selected and randomly divided into the observation group and the control group，each group had 48 cases.The control group was treated with Low Molecular Heparin Calcium，while the observation group was treated with Clopidogrel on the basis of the control group.And the curative effects，neurological deficit score （NIHSS） and the changes of plasma viscosity，fibrinogen，platelet aggregation rate and other hemodynamic parameters before and after treatment of the two groups were compared.Then the adverse reactions of the two groups were observed.Results The total effective rate of the observation group was 93.75%，and it was significantly higher than that of the control group （79.17%），and the difference was statistically significant （P<0.05）.NIHSS of the observation group was significantly lower than that of the control group after the treatment，and the difference was statistically significant （P<0.05）.In terms of hemodynamics，the plasma viscosity，fibrinogen and platelet aggregation rate in the observation group were significantly lower than those in the control group，and the difference was statistically significant （P<0.05）.there was no significant difference in the total incidence rate of adverse reactions between the two groups after treatment （P>0.05）.Conclusion Clopidogrel combined with Low Molecular Weight Heparin Calcium in the treatment of progressive ischemic stroke is effective and safe，and it has a higher application value in clinic.

[Key words]Clopidogrel；Low Molecular Weight Heparin Calium；Progressive ischemic stroke；Efficacy；Safety

进展性缺血性脑卒中是一种常见动脉粥样硬化性脑梗死发病形式[1]，其发病主要原因为颈内动脉和大脑中动脉阻塞，起病急，病情发展快，患者神经功能障碍逐渐发展，常呈阶梯样加重[2]。进展性缺血性脑卒中具有高致残率、致死率，严重威胁患者生命安全，随着近年来发病率的增加[3]，给家庭和社会带来了严重的负担。目前治疗进展性缺血性脑卒中主要采用单一低分子肝素钙，但研究发现单一低分子肝素钙治疗进展性缺血性脑卒中效果有限，且长期疗效不佳[4]。氯吡格雷作为一种血小板聚集抑制剂，已广泛用于脑卒中、心肌梗死等疾病中。……