CAJ | 학술논문

目的通过本研究探索负荷剂量氯吡格雷治疗进展性脑卒中的临床疗效及安全性。方法对发病48 h内入院120例进展性脑卒中患者随机分为治疗组和对照组，治疗组应用负荷剂量氯吡格雷治疗（首次300 mg，以后75 mg/d），对照组应用标准剂量氯吡格雷治疗（75 mg/d），两组连用14 d。两组患者基础治疗相同，有脑水肿者适当应用甘露醇脱水治疗。治疗前、治疗后72 h、第7天、第14天分别进行美国国立卫生研究院卒中量表（NIHSS）评分和Barthel指数（BI）评定，并于随访3个月时再评估。检测治疗前后血小板计数、凝血酶原时间及纤维蛋白原水平。用药第8天复查头颅CT或MRI，观察梗死灶面积是否扩大或出血。结果治疗后72 h、7 d、14 d，治疗组的NIHSS评分显著低于对照组（ P＜0.01）。血小板计数、凝血酶原时间、纤维蛋白原水平治疗前后比较差异无统计学意义（ P＞0.05）。复查头颅CT或MRI，治疗组有1例梗死灶出现点状出血，对照组未见脑出血；两组各1例皮疹；不良反应无统计学意义。完成3个月随访者98例，治疗组50例，BI≥75者35例（70.0％），有效率≥18％者40例（80.0％）；对照组48例，BI≥75者19例（39.6％），有效率≥18％者21例（43.8％）。治疗组BI≥75者比例明显高于对照组（ P＜0.01），治疗组有效率较对照组明显升高（ P＜0.01）。结论早期应用负荷剂量氯吡格雷明显较标准氯吡格雷更能防治缺血性脑卒中的进展，提高疗效，改善预后，未发现安全问题，值得进一步研究。
목적통과본연구탐색부하제량록필격뢰치료진전성뇌졸중적림상료효급안전성。방법대발병48 h내입원120례진전성뇌졸중환자수궤분위치료조화대조조，치료조응용부하제량록필격뢰치료（수차300 mg，이후75 mg/d），대조조응용표준제량록필격뢰치료（75 mg/d），량조련용14 d。량조환자기출치료상동，유뇌수종자괄당응용감로순탈수치료。치료전、치료후72 h、제7천、제14천분별진행미국국립위생연구원졸중량표（NIHSS）평분화Barthel지수（BI）평정，병우수방3개월시재평고。검측치료전후혈소판계수、응혈매원시간급섬유단백원수평。용약제8천복사두로CT혹MRI，관찰경사조면적시부확대혹출혈。결과치료후72 h、7 d、14 d，치료조적NIHSS평분현저저우대조조（ P＜0.01）。혈소판계수、응혈매원시간、섬유단백원수평치료전후비교차이무통계학의의（ P＞0.05）。복사두로CT혹MRI，치료조유1례경사조출현점상출혈，대조조미견뇌출혈；량조각1례피진；불량반응무통계학의의。완성3개월수방자98례，치료조50례，BI≥75자35례（70.0％），유효솔≥18％자40례（80.0％）；대조조48례，BI≥75자19례（39.6％），유효솔≥18％자21례（43.8％）。치료조BI≥75자비례명현고우대조조（ P＜0.01），치료조유효솔교대조조명현승고（ P＜0.01）。결론조기응용부하제량록필격뢰명현교표준록필격뢰경능방치결혈성뇌졸중적진전，제고료효，개선예후，미발현안전문제，치득진일보연구。
Objective To explore the clinical efficacy and safety of loading dose of Clopidogrel in the treatment of progressive stroke .Methods One hundred and twenty cases of progressive stroke patients who hospitalized within 48 h of falling ill were randomly divided into treatment group and control group .The treatment group were treated with loading dose of Clopidogrel ( first 300 mg,after 75 mg/d) for 14 d.The control group were treated with standard dose of clopidogrel (75 mg/d) for 14 d.The basic treatment of the two groups ,who had cerebral edema accapted mannitol therapy , was same .The two groups were scored by the NIH Stroke Scale ( NIHSS ) and Barthel Index(BI)before and after 72 h,7 d,14 d of treatment,and re-evaluated in the 3-month follow-up.Platelet count ,prothrombin time ,and fibrinogen levels were detected before and after treatment .The two groups were reviewed by head CT or MRI in the eighth day to observe whether the infarction proportion expanding or bleeding . Results NIHSS scores of the treatment group were significantly lower than that in the control group after the treamtent of 72 h,7 d,14 d(P<0.01).The levels of platelet count ,prothrombin time and fibrinogen before and after treatment had no significant difference ( P>0.05 ) .One case of the treatment group had spotting in the infarction ,and no one of the control group had cerebral hemorrhage .Each one of the two groups had rash .The adverse reactions of the two groups was not significant .There were 98 patients completed the 3-month follow-up in the two groups . Treatment group included 50 patients,in which 35(70.0%)patients′BI were greater than or equal to 75,and 40 (80.0%)patients′efficiency were greater than or equal to 18%.Control group included 48 patients,in which 19 (39.6%)patients′BI were greater than or equal to 75,and 21(43.8%) patients′efficiency were greater than or equal to 18%.The proportion of BI greater than or equal to 75 of the treatment group was significantly higher than that of the control group ( P<0.01 ) ,and the efficiency of the treatment group was significantly higher than that of the control group ( P<0.01 ) .Conclusion It is more effective to prevent the progress of ischemic stroke with loading dose of clopidogrel than standard dose of clopidogrel in the early treatment of progressive stroke , and it also can improve efficacy and prognosis .This method is found no safety issues and worth further study .