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目的探讨早期应用阿斯匹林和氯吡格雷双抗血小板联合丁苯酞对急性缺血性脑卒中患者凝血功能和氧化应激以及炎症介质的影响。方法选择2015年3月至2016年6月收治的96例急性缺血性脑卒中患者,按随机、对照临床研究方法,分为对照组48例和实验组48例。除常规治疗措施外,对照组予以双抗血小板(阿司匹林肠溶片100 mg口服,每日1次;氯吡格雷75 mg口服,每日1次)治疗;实验组予以双抗血小板联合丁苯酞(丁苯酞注射液25 mg静脉滴注,每日2次)治疗,共治疗2周为1个疗程。干预前后采血测定凝血功能及血液流变学指标、氧化应激以及炎症介质指标,观察并记录蒙特利尔认知评估(Mo CA)评分、Barthel评分和美国国立卫生研究院卒中量表评分(NIHSS),同时对比临床疗效和不良反应状况。结果与干预前比较,两组患者干预2周后Mo CA评分、Barthel评分升高,NIHSS评分降低,血浆D-二聚体(DDI)、纤维蛋白酶原(FIB)含量、全血高切黏度(HSV)、血浆黏度(PSV)降低,血清一氧化氮(NO)、丙二醛(MDA)水平降低,超氧化物歧化酶(SOD)、过氧化氢酶(CAT)水平升高,血清C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平降低(P均<0.01)。与对照组比较,实验组干预2周后Mo CA评分、Barthel评分及血清CAT、SOD水平升高,NIHSS评分和血浆DDI、FIB血清、NO、MDA、CRP、IL-6、TNF-α水平及全血HSV、PSV值降低(P均<0.05);对照组治疗有效率为75.00%,实验组有效率为91.67%,实验组高于对照组(P<0.05)。两组间不良反应发生率无统计学差异(P>0.05)。结论早期应用双抗血小板联合丁苯酞治疗急性缺血性脑卒中疗效确切,可改善患者凝血功能及氧化应激和炎症介质指标。
Objective To investigate the effect of early application of aspirin and clopidogrel combined with butylphthalide on coagulation, oxidative stress and inflammatory mediators in patients with acute ischemic stroke. Methods 96 cases of acute ischemic stroke admitted from March 2015 to June 2016 were randomly divided into control group (48 cases) and experimental group (48 cases). In addition to conventional treatment, the control group were treated with dual antiplatelet (aspirin enteric-coated tablets 100 mg orally once daily; clopidogrel 75 mg orally once daily); the experimental group was treated with dual anti-platelet combined with butylphthalide (Butylphthalide injection 25 mg intravenous infusion, 2 times a day) treatment, a total of 2 weeks for a course of treatment. Blood samples were collected before and after intervention to determine coagulation, hemorheology, oxidative stress and inflammatory mediators. MoCA score, Barthel score and NIHSS score were observed and recorded. At the same time compare the clinical efficacy and adverse reactions. Results Compared with those before intervention, MoCA score, Barthel score, NIHSS score, plasma D-dimer (DDI), fibrinogen (FIB) HSV, PSV, serum nitric oxide (NO) and malondialdehyde (MDA), the levels of superoxide dismutase (SOD) and catalase (CAT) (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were decreased (all P <0.01). Compared with the control group, MoCA score, Barthel score, serum CAT and SOD levels, NIHSS score, serum DDI, serum FIB, NO, MDA, CRP, IL-6 and TNF- The levels of HSV and PSV in whole blood decreased (P <0.05). The effective rate of the control group was 75.00%. The effective rate of the experimental group was 91.67%. The experimental group was higher than the control group (P <0.05). The incidence of adverse reactions between the two groups showed no significant difference (P> 0.05). Conclusion The early use of dual antiplatelet combined with butylphthalide in the treatment of acute ischemic stroke is effective and can improve coagulation function, oxidative stress and inflammatory mediators.