| 林晓慈,祝岱军,沈国谷,童璐莎.急性期非大面积心源性脑栓塞患者的早期抗凝治疗[J].浙江中西医结合杂志,2025,35(8): |
| 急性期非大面积心源性脑栓塞患者的早期抗凝治疗 |
| Early anticoagulant therapy for patients with acute non-massive cardiogenic cerebral embolism |
| 投稿时间：2024-07-31 修订日期：2025-02-24 |
| DOI： |
| 中文关键词: 抗凝治疗 急性期 心源性脑栓塞 神经功能 |
| 英文关键词:Anticoagulant therapy Acute stage Cardiogenic cerebral embolism Neural function |
| 基金项目:舟山市卫生健康委员会医药卫生科技项目(2021YB09) |
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| 中文摘要: |
| 【】 目的 探讨早期抗凝治疗急性期非大面积心源性脑栓塞(CCE)患者的有效性和安全性。方法 选取本院2021年 1月至2023年6月收治的140例急性期非大面积CCE患者作为研究对象,采用随机数字表法分为对照组和观察组,每组70例。对照组采用阿司匹林治疗,观察组采用早期抗凝治疗。以治疗后30d和90d的美国国立卫生院卒中量表(NIHSS)评分和改良的Rankin量表(mRS)评分、治疗90d临床转归情况作为主要结局指标,以安全性作为次要结局指标,比较两组主要结局指标和次要结局指标的差异,并根据临床转归情况,采用多因素分析方法对临床转归的影响因素进行分析。结果 治疗后30d、90d,两组NIHSS评分和mRS评分呈降低趋势,均低于治疗前,且观察组低于对照组(P＜0.05)。两组出血事件发生率、死亡率差异无统计学意义(P＞0.05),但观察组再发率(1.43%)低于对照组(11.43%)(P＜0.05)。 观察组治疗90d良好转归率(91.43%)高于对照组(78.57%)(P＜0.05)。多因素分析显示,年龄、发病时mRS评分、发病时NIHSS评分、启动抗凝时间是急性期非大面积CCE患者良好转归的危险因素,接受早期抗凝治疗是急性期非大面积CCE患者良好转归的保护因素(P＜0.05)。结论 早期抗凝治疗急性期非大面积CCE患者可以减轻神经功能缺损,提高良好转归率,降低再发率,且未显著增加出血风险,同时,年龄、发病时mRS评分、发病时NIHSS评分、启动抗凝时间是急性期非大面积CCE患者良好转归的危险因素,接受早期抗凝治疗是急性期非大面积CCE患者良好转归的保护因素。 |
| 英文摘要: |
| 【】? Objective To investigate the efficacy and safety of early anticoagulant therapy in patients with acute non-massive cardiogenic cerebral embolism (CCE). Methods 140 patients with acute non-large area CCE treated in our hospital from 1/2021 to 6/2023 were selected as the study objects, and were divided into control group and observation group by random number table method, with 70 cases in each group. The control group was treated with aspirin, and the observation group was treated with early anticoagulation. National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score at 30 and 90 days after treatment, clinical outcomes at 90 days after treatment were used as primary outcome indicators, and safety were used as secondary outcome indicators.The differences of primary outcome and secondary outcome were compared between the two groups.According to the clinical outcome,Multi-factor analysis was used to analyze the influencing factors of clinical outcome.Results At 30d and 90d after treatment, the NIHSS score and mRS Score in two groups showed a decreasing trend, both of which were lower than before treatment, and the observation group were lower than the control group (P<0.05). There was no significant difference in the incidence of bleeding events and mortality between the two groups (P>0.05), but the recurrence rate of observation group (1.43%) was lower than that of control group (11.43%) (P<0.05). The good outcome rate of observation group (91.43%) after 90 days of treatment was higher than that of control group (78.57%) (P<0.05). Multivariate analysis showed that age, mRS Score at onset, NIHSS score at onset, and initiation time of anticoagulation were risk factors for good outcome in acute non-large area CCE patients, and receiving early anticoagulation therapy was protective factor for good outcome in acute non-large area CCE patients (P<0.05).Conclusion? Early anticoagulation therapy in acute non-large area CCE patients can alleviate neurological deficits, improve the good outcome rate, reduce recurrence rate, and do not significantly increase the risk of bleeding. Age, mRS Score at onset, NIHSS score at onset and initiation time of anticoagulation were risk factors for good outcome in acute non-large area CCE patients, and receiving early anticoagulation therapy was protective factor for good outcome in acute non-large area CCE patients. |
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