【摘要】 目的探讨抗血小板药物应用在伴有无症状脑梗死(SCI)的老年缺血性卒中患者中的安全性。方法对2010年7—12月中山大学附属第一医院60岁以上首次发病的缺血性卒中住院患者进行磁共振检查。入选磁共振上除责任病灶外伴有(A组)和不伴有SCI(B组)的患者,同时期入选60岁以上存在高血压和(或)糖尿病需进行缺血性脑血管病一级预防的SCI者(C组)。记录临床和影像学资料,同时给予抗血小板药物治疗以及其他标准防治措施,随访2年,比较出血性事件和死亡情况。结果随访完整的230例患者中共发生出血性事件27例,其中脑出血5例,胃肠道出血12例,皮肤黏膜出血10例,3组之间差异无统计学意义。167例使用阿司匹林,63例使用氯吡格雷,脑出血(2.40%对1.59%),胃肠道出血(5.39%对4.76%)和皮肤黏膜出血(4.79%对3.17%)的发生率在使用阿司匹林和氯吡格雷的患者中差别不大。但在存在SCI的患者中(A+C组)使用拜阿司匹林患者总体出血发生率高于氯吡格雷患者(12.5%对8.33%,P<0.05)。结论伴有SCI的缺血性卒中患者应用抗血小板治疗出血并发症未见明显增加,其中氯吡格雷可能安全性更高。更多还原

【Abstract】 Objective To explore the safety of antiplatelet drugs in elderly ischemic stroke patients with silent cerebral infarctions(SCI).Methods Patients with acute infarction accompanied with SCI(Group A) or without SCI(Group B) were enrolled into this study.At the mean time,patients with hypertension and / or diabetes who underwent magnetic resonance imaging(MRI) examination and were found with silent infarctions were also included(Group C).Clinical data and imaging data were recorded.Antiplatelet drugs and other standard treatment were given to all of the patients.Two-year follow-up was performed in all patients.The incidence rates of hemorrhage and death were compared among groups.Results 230 patients finished the follow-up.Hemorrhage occurred in 27 patients,5 of whom were with cerebral hemorrhage,12 with gastrointestinal bleeding and 10 with mucocutaneous hemorrhage.The difference among the three groups was not significant.Aspirin was used in 167 patients and Clopidogrel was used in 63 patients.The incidences of cerebral hemorrhage(2.40% vs 1.59%),gastrointestinal bleeding(5.39 vs 4.76%),mucocutaneous hemorrhage(4.79 vs 3.17%) were found not significantly different between the patients treated with Aspirin and Clopidogrel(P > 0.05).But among patients with SCI(those in Gourp A and C),the incidences of hemorrhage were higher in the patients treated by Aspirin than that by Clopidogrel(12.5% vs 8.33%,P < 0.05).Conclusion Use of antiplatelet drugs do not lead to an obvious increase in the incidence of hemorrhage in SCI patients.In patients with SCI,Clopidogrel treatment may be safer than Aspirin.更多还原