他汀类降脂药能降低缺血性脑卒中患者再发卒中的风险

目的 观察他汀类药物在缺血性脑卒中二级预防中的作用.方法 将2006年以来在本院住院治疗的脑卒中/TIA患者60例随机分为他汀干预组和对照组.对照组仅接受康复治疗及危险因素治疗,干预组在对照组治疗基础上加用阿托伐他汀20 mg 1次/d治疗,观察3年内两组患者再发脑卒中/TIA,死亡以及其他心血管事件发生率.结果 干预组再发脑卒中/TIA,冠脉事件发生率低于对照组,而死亡率,脑出血发生率两组却无明显差异.结论 他汀类药物能有效预防脑卒中/TIA患者再发心脑血管事件的发生.     

他汀类降脂药能降低缺血性脑卒中患者再发卒中的风险

目的观察他汀类药物在缺血性脑卒中二级预防中的作用。方法将2006年以来在本院住院治疗的脑卒中／TIA患者60例随机分为他汀干预组和对照组。对照组仅接受康复治疗及危险因素治疗,干预组在对照组治疗基础上加用阿托伐他汀20mg1次／d治疗,观察3年内两组患者再发脑卒中／TIA,死亡以及其他心血管事件发生率。结果干预组再发脑卒中／TIA,冠脉事件发生率低于对照组,而死亡率,脑出血发生率两组却无明显差异。结论他汀类药物能有效预防脑卒中／TIA患者再发心脑血管事件的发生。     

他汀类药物预防缺血性脑卒中的7年临床研究

[目的]探讨他汀类药物对缺血性脑卒中预防作用.[方法]将3 245例缺血性脑卒中患者分为预防组(958例)和对照组(2 287例),预防组给予阿托伐他汀10 mg/d,晨起口服.分析两组血脂变化、心脑血管事件、脑卒中等差异.[结果]预防组受试者高血压患病率比对照组高.预防组低密度脂蛋白胆固醇较对照组低[(2.87±1.11)mmol/L vs(4.18±1.81)mmol/L,P＜0.05],而5年生存率则较高(92.19%vs 81.26%,P＜0.01),缺血性脑卒中和心脑血管事件发生率较低.[结论]他汀类药物能有效预防缺血性脑卒中的发生,降低血脂异常人群的心脑血管事件.     

阿托伐他汀联合阿司匹林治疗短暂性脑缺血发作的疗效

目的观察阿托伐他汀联合阿司匹林治疗短暂性脑缺血发作(TIA)的临床疗效。方法将86例TIA患者按随机数字表法分为2组:观察组43例应用阿托伐他汀及阿司匹林口服治疗,对照组43例应用阿司匹林口服,均治疗1年,观察2组发生非致死性脑梗死和再发TIA的情况。结果观察组非致死性脑梗死和再发TIA的发生率分别为9.3%、7.0%,明显低于对照组(18.6%、16.3%),2组相比差异均有统计学意义(P<0.05)。结论阿托伐他汀联合阿司匹林治疗TIA疗效优于单独应用阿司匹林治疗。     

他汀类药物预防脑梗死再发的效果评价

目的:观察他汀类药物预防脑梗死再发的效果。方法:选取脑梗死伴有颈动脉粥样硬化患者48例,随机分治疗组与对照组,治疗组应用他汀类药物联合阿司匹林治疗,对照组给予阿司匹林治疗,比较两组患者2年内脑梗死复发及颈动脉变化、血脂水平变化情况。结果:治疗组脑梗死复发为率3.8%,对照组复发率为31.8%,两者比较差异有统计学意义(P<0.05);治疗组颈动脉斑块面积、颈动脉内膜-中层厚度、血脂水平均优于对照组,差异有统计学意义(P<0.05)。结论:他汀类药物联合应用阿司匹林能有效预防脑梗死的再发。     

阿托伐他汀对糖尿病并TIA患者高敏C-反应蛋白影响的临床意义

目的探讨阿托伐他汀对糖尿病并短暂性脑缺血发作（TIA）患者血脂、高敏C-反应蛋白（hs-CRP）的影响及其临床意义。方法选择糖尿病并TIA患者160例随机分为治疗组80例和对照组80例,对照组常规饮食控制、降糖药物、肠溶阿司匹林75 mg 1次/d口服1 a,低分子肝素纳5 000 U 1次/d皮下注射1周。治疗组在对照组治疗基础上给予阿托伐他汀20 mg每晚顿服1 a。两组均于入院24 h内及治疗后4周测定血脂及hs-CRP值,分析1 a脑卒中事件的发生率。结果治疗组hs-CRP、TC、LDL-C明显低于治疗前（P〈0.05）,HDL-C高于治疗前变化均有统计学意义（P〈0.05）。TG治疗前后差异无统计学意义（P〉0.05）。对照组治疗前后各指标差异无统计意义（P〉0.05）,治疗组1 a内脑卒中事件发生率显著低于对照组（P〈0.01）。结论：阿托伐他汀的调脂及减轻炎症反应作用确定,可改善血管内及功能,预防动脉硬化进展,对糖尿病并TIA的发生、发展及预后有重要作用。     

氯吡格雷与替格瑞洛在他汀类药物致肝功能损害的老年急性冠脉综合征患者中的疗效及安全性

目的探讨氯吡格雷与替格瑞洛在他汀类药物致肝功能损害的老年急性冠脉综合征(ACS)患者中的有效性与安全性。方法将160例老年ACS患者随机分为对照组与观察组,每组80例。对照组采用氯吡格雷治疗,观察组采用替格瑞洛治疗。观察2组患者药物治疗3、7、30 d的血小板聚集率、心脑血管不良事件(复发心绞痛、心力衰竭、心肌梗死、脑卒中)发生情况、用药安全性(随访2个月和1年的主要出血事件、次要出血事件、呼吸困难和肌酐升高)。结果观察组药物治疗3、7、30 d的血小板聚集率均显著低于对照组(P 0. 05)。对照组心脑血管事件发生率显著高于观察组(P 0. 05)。2组患者均未发生主要出血事件,观察组发生次要出血事件患者例数多于对照组,但差异无统计学意义(P 0. 05)。观察组随访2个月时呼吸困难发生率高于对照组,但随后显著减少,2组患者均未发生肌酐升高。结论替格瑞洛在治疗他汀类药物致肝功能损害的老年ACS患者中安全性高,患者均未出现主要的出血事件和呼吸困难症状,心脑血管事件的发生率低。     

脑卒中二级预防护理干预的临床效果观察

目的:探讨脑卒中二级预防护理干预的临床效果。方法:对2014年9月至2015年12月住院部缺血性脑卒中/短暂性脑缺血发作(TIA)患者,采用ESSEN卒中评分量表(ESRS评分)进行脑卒中再发风险评估。共筛查800例脑卒中复发风险高危患者,随机分为观察组和对照组各400例,观察组根据脑卒中风险评估对患者进行分级管理和个体化的干预,对照组给予常规护理,观察两组患者服药,复诊的依从性和复发率。结果:观察组的服药依从性和复诊率于出院后3个月,6个月均高于对照组,出院后6个月时卒中复发率低于对照组。结论:对缺血性脑卒中患者采用规范化二级预防护理干预,可以提高患者依从性和降低复发率。     

短暂脑缺血发作早期应用辛伐他汀临床疗效观察

短暂脑缺血发作(TIA)是完全性脑卒中的重要危险因素,未经治疗的TIA约有1/3以上患者以后发展为脑梗死,在TIA之后的第1年内发生脑卒中的危险性最高.多种因素均可引起TIA发作,他汀类药物除具有调节血脂作用外,尚具有改善血管内皮功能及逆转受损内皮功能的作用[1],作者自2001年6月至2004年5月在TIA早期应用辛伐他汀,探讨他汀类药物在TIA中的作用.     

预防脑梗死再发联合治疗方案5年对照研究

目的 探讨预防脑梗死再发联合治疗方案的效果、终点事件发生及安全性的对照研究.方法 初发性脑梗死患者978例,随机分为治疗组626例,对照组352例,治疗组给予个体化血压调治技术,联合抗血小板治疗及危险分层下小剂量辛伐他汀达标,三大类药物构成一体化的治疗方案.对照组给予降压、单纯阿司匹林抗血小板及危险分层下小剂量辛伐他汀达标的治疗方案.比较两组3年和5年后脑梗死再发率、终点事件发生率、不良反应及依从性情况.结果 治疗组治疗后3年和5年脑梗死再发率、心脏事件发生率均明显低于对照组,5.4%vs 13.6%、7.8%vs21.0%、5.8%vs 11.6%(P<0.01),治疗后5年总病死率低于对照组,4.2%vs 7.1%(P<0.05).治疗组治疗后3年和5年功能健康水平均高于对照组(P<0.05).治疗组头痛发生率高于对照组(P<0.05).两组脑出血、肝酶升高、消化道出血、癌症的发生率差异均无统计学意义(P>0.05).对照组退出率高于治疗组,13.6%vs 5.3%(P<0.01).结论 预防脑梗死再发联合治疗方案,在脑梗死二级预防中能显著降低脑梗死再发率、心脏事件发生率和病死率,极大的提高了功能健康水平.患者对药物依从性好,而且安全性也好.     

Recurrent vascular events in patients with ischemic stroke/TIA and atrial fibrillation in relation to secondary prevention at hospital discharge

BACKGROUND: Oral anticoagulation is indicated in secondary prevention of stroke or transient ischemic attack (TIA) in patients with atrial fibrillation, but it is often withheld because of contraindications and/or fear of bleeding complications. METHODS: We analysed recurrent cerebral and non-cerebral ischemic vascular events, major intracerebral and extracerebral bleeding and vascular death in 401 consecutive patients with ischemic stroke or TIA and atrial fibrillation who were discharged with oral anticoagulation (OAC), antiplatelet agents (AA), or heparin only in a clinical routine setting. The median follow-up time was 25 (interquartile range (IQR): 15-38) months. RESULTS: Patients on OAC at time of discharge were significantly younger and had suffered a major stroke less often than patients who received AA or heparin at discharge. One year after discharge, adherence to therapy was higher in patients discharged on OAC (72%) than in those on AA (46%; p<0.001). The majority of patients discharged on heparin were subsequently treated with OAC. Patients on AA at discharge suffered from ischemic complications significantly more often during the follow-up period than patients on OAC or heparin at discharge (30% vs. 16% vs. 23%, p=0.031). 3% of the patients on AA and 4% of those on OAC suffered from major bleeding complications during follow-up (p=0.028). CONCLUSION: Our results document the high risk of ischemic vascular complications in patients with ischemic stroke/TIA and atrial fibrillation in a clinical routine setting. The risk was particularly high in patients treated with AA. The risk of major bleeding complications in our population was comparably low.     

High-dose statin therapy for secondary prevention of stroke: stroke prevention by aggressive reduction in cholesterol levels study review

It has been shown that HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) lower the incidence of a first stroke in patients with coronary heart disease, diabetes, or risk factors for cardiovascular disease. However, it is unknown whether statin therapy could reduce the incidence of a second stroke in patients without evidence of heart disease. This article reviews the results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial, a prospective, randomized, multicentered, double-blind, placebo-controlled, international trial designed to examine the effect of high-dose atorvastatin on secondary stroke prevention. Trial participants (4,731) had experienced a stroke or transient ischemic attack within 1 to 6 months before randomization into the study. Over the 5-year follow-up period, incidence of second stroke or transient ischemic attack was significantly reduced in the atorvastatin treatment group compared with the placebo group. In addition, high-dose atorvastatin therapy significantly decreased major coronary artery and other negative cardiovascular events. The reduction in incidence of secondary stroke was specific to ischemic stroke as opposed to hemorrhagic stroke. Results of the trial are clinically significant and support extension of the latest secondary stroke prevention guidelines to include statin therapy for those patients without coronary heart disease.     

氯吡格雷联合阿司匹林治疗短暂性脑缺血发作的系统评价

目的：系统评价氯吡格雷联合阿司匹林治疗短暂性脑缺血发作的疗效及安全性。方法：利用计算机检索数据库全面查找氯吡格雷联合阿司匹林治疗短暂性脑缺血发作的随机对照试验,同时检索纳入研究的参考文献,检索时限截至2013年10月。按预先设定的标准筛检文献,对合格文献提取数据并进行质量评价,运用Meta分析进行评价。利用Cochran RevMan 5.0软件进行Meta分析。结果：共纳入7个相关随机对照试验,共3517例患者。试验组采用氯吡格雷联合阿司匹林治疗,对照组单用阿司匹林治疗。试验组发生脑梗塞的比率低于对照组[OR=0.63,95%CI（0.49,0.80）],有6个试验报道了不良事件,主要是出血及凝血功能障碍,但试验组与对照组比较,无显著差异[OR=1.38,95%CI（0.84,2.28）]。结论：此次Meta分析的结果显示短暂性脑缺血发作患者接受氯吡格雷和阿司匹林治疗,能有效降低患者脑卒中风险,且未见严重的不良反应,治疗安全有效。氯吡格雷联合阿司匹林治疗短暂性脑缺血发作的远期预后还需进行更多的研究。     

Preventing stroke in patients with transient ischemic attacks

Stroke is the third most common overall cause of death and the leading cause of adult disability in the United States. New therapeutic interventions instituted in the period immediately after a stroke have revolutionized the approach to ischemic cerebrovascular disease. Recognition of a transient ischemic attack provides an opportunity to prevent a subsequent stroke. Specific stroke prevention treatment depends on the cause of the transient ischemic attack, its cerebrovascular localization and the presence of associated coexisting medical problems. Modification of stroke risk factors is the principal therapeutic approach. Antiplatelet agents and anticoagulants have been shown to be effective in reducing the occurrence of stroke in certain populations. Several well-designed studies have recently demonstrated the effectiveness of carotid endarterectomy in preventing strokes related to extracranial carotid artery disease.     

短暂性脑缺血发作后卒中危险性的评估及干预效果的临床研究

目的评估短暂性脑缺血发作（TIA）患者发生卒中的危险性及抗血小板剂的干预效果。方法256例TIA患者随机分为干预组和对照组，各128例。对照组予一般措施及安慰剂，干预组在一般措施上加用氯吡格雷（75mg／d），并分别在发病后7d、1、3、6个月比较两组卒中发病率、症状、体征和神经功能缺损评分情况，并监测血液流变学情况。结果对照组7d、1、3、6个月时卒中发生率分别为8．59％，14．06％，21．09％和28．13％；干预组为0．00％，4．69％，8．59％和11．72％，两组存在显著差异（P〈0．05）。干预组在研究后血液流变学改变、卒中患者病理征出现、脑梗死面积、神经功能缺损评分等方面，亦与对照组存在显著差异（P〈0．05）。结论TIA后卒中危险性比普通人群高得多，须及早二级预防，抗血小板药物效果确切，且安全。     

短暂性脑缺血患者大脑中动脉闭塞性病变与卒中危险性分析

目的探讨伴有MCA狭窄的短暂性脑缺血患者卒中事件的发生率及其危险因素。方法通过TCD及MRA选择96例伴MCA狭窄的TIA患者,随访1年,观察卒中事件的发生率及其相关危险因素。结果96例伴MCA狭窄的TIA患者1年内卒中事件的发生率为14.6%,MCA轻中度狭窄、重度狭窄及闭塞的TIA患者卒中事件的发生率不同(4.9%、20.0%、60.0%,均P<0.05);卒中者与非卒中者危险因素的聚集率不同(57.1%vs29.3%,P<0.05)。Logisti回归分析显示,伴MCA狭窄的TIA患者卒中事件的发生与MCA狭窄程度、危险因素的聚集及未服用抗血小板制剂密切相关(OR=0.261、0.149、0.203,均P<0.05)。结论短暂性脑缺血患者大脑中动脉闭塞性病变卒中危险性与MCA狭窄程度、危险因素的聚集及未服用抗血小板制剂有关。     

Transient ischemic attacks: Part I. Diagnosis and evaluation

Transient ischemic attack is no longer considered a benign event but, rather, a critical harbinger of impending stroke. Failure to quickly recognize and evaluate this warning sign could mean missing an opportunity to prevent permanent disability or death. The 90-day risk of stroke after a transient ischemic attack has been estimated to be approximately 10 percent, with one half of strokes occurring within the first two days of the attack. The 90-day stroke risk is even higher when a transient ischemic attack results from internal carotid artery stenosis. Most patients reporting symptoms of transient ischemic attack should be sent to an emergency department. Patients who arrive at the emergency department within 180 minutes of symptom onset should undergo an expedited history and physical examination, as well as selected laboratory tests, to determine if they are candidates for thrombolytic therapy. Initial testing should include complete blood count with platelet count, prothrombin time, International Normalized Ratio, partial thromboplastin time, and electrolyte and glucose levels. Computed tomographic scanning of the head should be performed immediately to ensure that there is no evidence of brain hemorrhage or mass. A transient ischemic attack can be misdiagnosed as migraine, seizure, peripheral neuropathy, or anxiety.     

短暂性脑缺血发作患者经颅多普勒超声和CT检查结果比较

背景短暂性脑缺血发作是完全性脑卒中的危险因素.通过影像学和超声等检测手段早期发现短暂性脑缺血发作并及时干预以防止发展为完全性脑卒中.目的比较经颅多普勒超声和CT检查对短暂性脑缺血发作的早期评估价值.设计病例分析.单位一所区级医院神经内科、CT室、经颅多普勒超声室.对象赤峰市元宝山区医院2001-01/2003-04门诊和住院的短暂性脑缺血发作患者30例,男22例,女8例;年龄26～85岁,平均年龄59.6岁.干预短暂性脑缺血发作患者30例住院后均给予常规量活血通脉、肝素或低分子肝素钙治疗,所有入选患者均行头颅CT检查,并采用经颅多普勒超声诊断系统检测双侧颈内动脉、椎基底动脉的收缩期流速舒张期流速、平均血流速度及脉动指数等有关动力学的情况.通过随访1个月和1年观察发生脑梗死情况.主要观察指标①头颅CT检查结果.②经颅多普勒超声检查结果.③30例患者随访1个月和1年发生脑梗死情况.结果在出院后1个月和1年时30例患者全部获得随访.①CT检查10例有病灶性改变,占34%(10/30).②经颅多普勒超声检查24例有血流异常改变,占80%(24/30).③30例应用肝素或低分子肝素钙治疗的短暂性脑缺血发作患者,1个月之内发生脑梗死4例,1个月～1年发生脑梗死6例.结论对于短暂性脑缺血发作患者,经颅多普勒超声检查发现血流异常情况早于CT检查,短暂性脑缺血发作后要及早给予抗凝治疗,可使短暂性脑缺血发作再发率减少,预防完全性脑卒中的发生.