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目的:研究在脑梗死患者的二级预防中阿司匹林抵抗现象和相应的干预措施的应用效果。方法:选取龙川县人民医院2014年8月至2016年2月收治的140例脑梗死患者,患者入院后均每晚顿服拜阿司匹林,在连续用药1周后对其血小板聚集率(MAR)进行检测,结合检测结果筛选出105例阿司匹林抵抗、半反应患者(将其随机地分入3组,A组35例改用氯吡格雷,B组35例改用阿司匹林与氯吡格雷的联合疗法,C组35例继续使用拜阿司匹林和D组35例敏感者(续服拜阿司匹林),在连续用药10 d后,需要复查4组患者的MAR,对比4组患者缺血性事件的发生率。结果:调整后,A组花生四烯酸(AA)诱导MAR要显著高于调整前,但是其二磷酸腺苷(ADP)诱导MAR要显著低于调整前,差异具有统计学意义(P<0.05);调整后,B组的AA诱导和ADP诱导MAR均显著降低,差异具有统计学意义(P<0.05);与A、C、D组相比,B组缺血性事件的发生率明显较低,差异具有统计学意义(P<0.05),而其余3组的缺血性事件的发生率相比,差异均无统计学意义(P>0.05)。结论:脑梗死二级预防中,患者容易出现阿司匹林抵抗现象,及时地对其行阿司匹林及氯吡格雷联合治疗能够使患者的阿司匹林抵抗现象显著改善,并能够降低缺血性事件的发生率。
Objective: To study the effect of aspirin resistance in secondary prevention of cerebral infarction and corresponding interventions. Methods: One hundred and forty patients with cerebral infarction who were treated in Longchuan County People’s Hospital from August 2014 to February 2016 were enrolled in this study. All patients were served with aspirin every night after hospitalization. The platelet aggregation rate (MAR) 105 cases of aspirin-resistant and half-reaction patients were screened out (randomly divided into three groups, 35 cases in group A were switched to clopidogrel, and 35 cases in group B were switched to combination therapy with aspirin and clopidogrel 35 patients in group C continued to use aspirin and 35 patients in group D were treated with aspirin. After 10 days of continuous administration, the MAR of 4 patients were reviewed, and the incidence of ischemic events in 4 patients was compared. Results: After adjustment, MAR of AA group was significantly higher than that of AA group (P <0.05), but its AD induced by ADP was significantly lower than that before adjustment (P <0.05 ). After adjustment, MAR in group B induced by AA and ADP decreased significantly, the difference was statistically significant (P <0.05). Compared with group A, C and D, the incidence of ischemic events in group B was significantly higher than that in group B Low, the difference was statistically significant (P <0.05), while the remaining three groups compared to the incidence of ischemic events, the difference was not statistically significant (P> 0.05) .Conclusion: In secondary prevention of cerebral infarction, aspirin resistance is prone to appear in patients, and the combination of aspirin and clopidogrel in time can significantly improve aspirin resistance in patients and reduce ischemia The incidence of sexual events.