王英滨 陶乃溶 高飞 王刚 于洋 张浩 潘海

[摘要] 目的 探討长期服用阿司匹林后脑出血患者的临床治疗方案。 方法 选取2015年6月至2019年6月在沈阳医学院附属中心医院神经外科就诊的口服阿司匹林后脑出血患者78例。根据治疗方法分为观察组和对照组各39例，观察组进行血栓弹力图（Thrombelastogram，TEG）检测和（或）输血小板治疗，对照组进行常规治疗。术后24 h 内复查头部CT 测量出血量，比较两组再出血率和再出血量。术后4周依据美国国立卫生研究院脑卒中量表（National Institute of Health stroke scale，NIHSS）、Barthel指数（Barthel index，BI）以及格拉斯哥昏迷评分（Glasgow coma scale，GCS）评估患者预后情况。 结果 观察组再出血率显著降低，再出血量也显著减少，差异有统计学意义（P<0.05）。观察组NIHSS评分显著降低，差异有统计学意义（P<0.05），观察组患者神经功能恢复较好;BI评分显著升高，差异有统计学意义（P<0.05），观察组患者治疗后生活质量更高;GCS评分显著升高，差异有统计学意义（P<0.05），观察组患者治疗后昏迷程度较低。 结论 对于长期服用阿司匹林脑出血患者，立即停药并且进行TEG检测，进行个体化输血小板治疗，减少再出血的风险，改善患者预后，提高患者生活质量。

[关键字] 阿司匹林;脑出血;血栓弹力图;血小板

[中图分类号] R743.34          [文献标识码] B          [文章编号] 1673-9701（2021）08-0060-04

Analysis on the clinical treatment of cerebral bleeding patients after long-term administration of aspirin

WANG Yingbin1   TAO Nairong2   GAO Fei1   WANG Gang1   YU Yang1   ZHANG Hao1   PAN Hai1

1.Department Ⅱ of Neurosurgery， Central Hospital Affiliated to Shenyang Medical College， Shenyang   110024， China;

2.Shenyang Medical College， Shenyang   110034， China

[Abstract] Objective To investigate the clinical treatment of cerebral bleeding patients after long-term administration of aspirin. Methods A total of 78 patients with cerebral bleeding after oral administration of aspirin from June 2015 to June 2019 were selected from the department of neurosurgery， Central Hospital Affiliated to Shenyang Medical College. According to the treatment methods， patients were divided into the observation group（n=39） and the control group（n=39）. The observation group was given thrombelastogram（TEG） test and/or platelet transfusion treatment， while the control group was given conventional treatment. Within 24 hours after operation， the head CT was reexamined to measure the bleeding volume， and the recurrent bleeding rate and rebleeding volume were compared between the two groups. The prognoses of patients were evaluated according to the National Institute of Health stroke scale（NIHSS）， Barthel index（BI） and Glasgow coma scale（GCS） 4 weeks after operation. Results In the observation group， the recurrent bleeding rate and rebleeding volume decreased significantly， and the differences were statistically significant（P<0.05）. The NIHSS score in the observation group decreased significantly（P<0.05）， and the neurological function of the patients in the observation group recovered well. BI score increased significantly， and the difference was statistically significant（P<0.05）. Patients in the observation group had higher quality of life after treatment. The GCS score increased significantly， and the differences were statistically significant（P<0.05）. The coma degree of patients in the observation group was lower after treatment. Conclusion For patients with cerebral bleeding after long-term administration of aspirin， it is time to stop taking drugs immediately， perform TEG examination， and carry out individualized platelet transfusion treatment， so as to reduce the risk of rebleeding， improve the prognosis and increase the quality of life of patients.

[Key words] Aspirin; Cerebral bleeding; Thromboelastogram; Platelet

阿司匹林在心脑血管疾病一级和二级预防中的应用非常广泛，主要由于阿司匹林具有血小板抑制作用，常用于降低高血压、冠心病家族史、血脂异常、肥胖、糖尿病、吸烟史或年龄较大患者心肌梗死、脑梗死的发作风险和心、脑血管内植入支架的患者支架内血栓形成风险[1]。目前，随着我国老龄化的来临，人们文化水平和物质条件日渐提高，因此越来越多的中老年人开始重视疾病的预防，通过服用阿司匹林等血小板抑制类药物控制心脑血管疾病的发生。但是长期服用阿司匹林可能会影响患者的凝血功能，研究发现，长期服用阿司匹林增加了脑出血的发病率、死亡率及致残率[2]。另外长期口服阿司匹林的脑出血患者，再出血发生率高于未服用阿司匹林患者[3]。……