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目的探讨全脑血管造影在指导脑梗死二级预防中的应用价值。方法纳入240例首次发病的动脉粥样硬化性脑梗死患者,分为造影组124例及对照组116例。对照组根据指南给予常规二级预防处理,造影组接受全脑血管造影检查,评估血管病变,采取个体化的二级预防措施。随访观察2年,比较造影组及对照组脑梗死复发率,并分析其安全性。结果 (1)造影组及对照组在性别、年龄构成及ESRS分值、NIHSS分值方面差异无统计学意义(P>0.05);(2)对照组治疗情况:阿司匹林+常规他汀85例,占73.28%,氯吡格雷+强化他汀31例,占26.72%;造影组治疗情况:阿司匹林+常规他汀59例,占47.58%,氯吡格雷+强化他汀38例,占30.66%,给予双抗+强化他汀治疗27例,占21.76%,颈动脉支架植入4例,椎动脉支架植入2例;(3)随访2年对照组有26例复发(复发率22.41%),造影组有15例复发(复发率12.10%)(P<0.05)。结论全脑血管造影检查能准确地评估患者脑血管病变情况,能给患者提供个体化的二级预防措施,有效地降低脑梗死复发率。
Objective To investigate the value of whole cerebral angiography in the secondary prevention of cerebral infarction. Methods A total of 240 patients with first-onset atherosclerotic cerebral infarction were enrolled and divided into 124 patients in contrast group and 116 patients in control group. The control group was given routine secondary prevention according to the guidelines. The angiography group underwent whole-brain angiography to assess the vascular lesions and took individualized secondary prevention measures. The patients were followed up for 2 years. The recurrent rates of cerebral infarction in the contrast group and control group were compared and their safety was analyzed. Results (1) There was no significant difference in gender, age constitution, ESRS score and NIHSS scores between the contrast group and the control group (P> 0.05). (2) The treatment of the control group: 85 cases of aspirin + conventional statin 73.28%, clopidogrel plus statin 31 cases, accounting for 26.72%; contrast group treatment: aspirin + conventional statin 59 cases, accounting for 47.58%, clopidogrel + statin 38 cases, accounting for 30.66% There were 27 cases in statin group (21.76%), 4 cases in carotid stenting and 2 cases in vertebral artery stent implantation. (2) 26 cases were followed up for 2 years (recurrence rate was 22.41%), 15 cases (Recurrence rate 12.10%) (P <0.05). Conclusion Cerebral angiography can accurately assess the patients with cerebrovascular disease and provide patients with individualized secondary prevention measures to effectively reduce the recurrence rate of cerebral infarction.