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目的观察西乐他唑与阿司匹林在脑梗死二级预防中对脑血管状况和脑血流的影响,并作比较。方法选取在近1-6个月内有脑梗死病史患者68例,随机分配入西乐他唑和阿司匹林组。在入组时及用药12个月后,应用核磁共振血管成像(MRA)和经颅多普勒超声(TCD)方法评价患者脑血管状况。结果随访期间,西乐他唑组有2例患者再发脑梗死,而阿司匹林组有1例再发脑梗死,1例发生急性心肌梗死。MRA检测发现,西乐他唑组患者血管状况恶化和好转的比例分别为3.3%和6.7%,阿司匹林组分别为3.3%和10.0%。TCD检测显示西乐他唑和阿司匹林组患者血管状况恶化发生的比例分别为14.3%和26.9%。以上结果两组间均无统计学差异。服用西乐他唑12个月后,血流异常的血管中其收缩期血流峰值升高的比例高于阿司匹林组,分别为42.9%和27.5%。作为抗血小板治疗的主要副作用,出血事件在西乐他唑组发生0例,在阿司匹林组发生5例(P<0.05)。结论西乐他唑在脑梗死二级预防中同阿司匹林一样有效且比阿司匹林更为安全。西乐他唑能升高脑血管峰值血流速度,改善缺血灶血供。
Objective To observe the effects of cilostazol and aspirin on cerebrovascular status and cerebral blood flow in secondary prevention of cerebral infarction. Methods Sixty-eight patients with a history of cerebral infarction in the past 1-6 months were randomly assigned to receive cilostazol and aspirin. At enrollment and at 12 months after drug administration, MRA and TCD were used to assess cerebrovascular status. Results During follow-up, cerebral infarction was recurred in 2 of the patients in the cilostazol group and 1 of the patients in the aspirin group and 1 of the patients in the aspirin group. MRA test found that patients with cilostazol group of vascular deterioration and improvement in the proportion of 3.3% and 6.7%, respectively, aspirin group were 3.3% and 10.0%. The TCD test showed that the worsening of vascular status in patients receiving cilostazol and aspirin was 14.3% and 26.9%, respectively. The above results were no significant difference between the two groups. After 12 months of taking cilostazol, the proportion of systolic blood flow peak in abnormal blood vessels was higher than that in aspirin group, 42.9% and 27.5% respectively. As a major side effect of antiplatelet therapy, 0 occurred in the cilostazol group and 5 in the aspirin group (P <0.05). Conclusion Cilostazol is as effective as aspirin in secondary prevention of cerebral infarction and safer than aspirin. Cilostazol can increase the peak blood flow velocity in cerebrovascular and improve the blood supply of ischemic focus.