作者：李梦馨，王刚，张晓俊，王彬，王炎强，耿建红，庞萌

单位：

1.261031山东省潍坊市，潍坊医学院临床医学院　2.261031山东省潍坊市，潍坊医学院附属医院急诊科　3.261031山 东省潍坊市，潍坊医学院附属医院神经内科二病区

Units：

1.Weifang Medical University, School of Clinical Medicine, Weifang 261031, China 2.Emergency Department, Affiliated Hospital of Weifang Medical University, Weifang 261031, China 3.Neurology Second Ward, Affiliated Hospital of Weifang Medical University, Weifang 261031, China

关键词：

卒中；觉醒型脑卒中；血小板聚集抑制剂；静脉溶栓；治疗结果

Keywords：

Stroke; Wake-up stroke; Platelet aggregation inhibitors; Intravenous thrombolysis; Treatment outcome

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2023.00.256

Funds：

山东省医药卫生科技发展计划项目（202103070864）

摘要：

目的　探讨发病前抗血小板治疗（APT）对觉醒型脑卒中（WUS）患者静脉溶栓治疗有效性及安全性 的影响。方法　选取2016—2022年潍坊医学院附属医院神经内科收治的WUS患者107例，根据既往是否长期（1个月以 上）规律口服抗血小板药物将患者分为APT组32例和非APT组75例。入院后两组患者采用注射用阿替普酶进行静脉溶 栓治疗，溶栓前、溶栓后24 h、出院时采用美国国立卫生研究院卒中量表（NIHSS）评价两组患者神经功能状况，治 疗后90 d评价两组患者临床疗效，治疗后90 d采用改良Rankin量表评价两组患者预后，观察并记录两组患者住院期间 不良事件发生情况。结果　溶栓后24 h、出院时APT组患者NIHSS评分均低于非APT组（P＜0.05）。治疗后90 d，APT 组临床疗效优于非APT组，APT组预后良好率高于非APT组（P＜0.05）。两组症状性颅内出血（sICH）发生率、颅内 出血（ICH）发生率、总不良事件发生率比较，差异无统计学意义（P＞0.05）。结论　发病前APT可改善WUS患者静 脉溶栓治疗后神经功能，提高临床疗效，改善预后，且未增加不良事件发生风险。

Abstract：

Objective To investigate the efficacy and safety of premorbid use of anti-platelet therapy (APT) on intravenous thrombolysis therapy in patients with wake-up stroke (WUS) . Methods A total of 107 patients with WUS admitted to the Department of Neurology of Affiliated Hospital of Weifang Medical University from 2016 to 2022 were selected. The patients were divided into APT group (n=32) and non-APT group (n=75) according to whether taking anti-platelet drugs orally for a long time (more than one month) in the past. Patients in the two groups were treated with intravenous thrombolytic with alteplase injection after admission. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the neurological function of patients before thrombolysis, 24 h after thrombolysis and at discharge, the clinical efficacy of the patients was evaluated 90 days after treatment, and the improved Rankin Scale was used to evaluate the prognosis of patients 90 days after treatment. The occurrence of adverse events during hospitalization were observed and recorded. Results At 24 h after thrombolysis and at discharge, the NIHSS score in the APT group was lower than that in the non-APT group (P < 0.05) . Ninty days after treatment, the clinical efficacy in the APT group was better than that in the non-APT group, and the good prognosis rate in the APT group was higher than that in the non-APT group (P < 0.05) . There was no statistically significant difference in the incidence of symptomatic intracranial hemorrhage (sICH) , intracranial hemorrhage (ICH) , and total adverse event between the two groups ( P > 0.05) . Conclusion Premorbid use of APT can improve neurological function, clinical efficacy, and prognosis in patients with WUS treated by intravenous thrombolysis therapy, without increasing the incidence of adverse events.

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