目的 探讨合并胃癌的急性缺血性脑卒中(acute ischemic stroke,AIS)患者应用阿司匹林抗血小板治疗的有效性及安全性.方法 回顾性分析 2018 年 1 月至 2022 年 10 月在湖州市第一人民医院住院治疗的 89 例合并胃癌的AIS患者的临床资料.根据是否进行抗血小板治疗,将患者分为治疗组 59 例和未治疗组 30 例,比较两组患者的临床特点和预后情况,并分析合并胃癌的 AIS 患者抗血小板治疗并发消化道出血的临床特点及影响因素.结果 治疗组患者的年龄小于未治疗组,且既往多有抗血小板治疗用药史、高血压病和心血管病史,差异有统计学意义(P<0.05);治疗组患者抗血小板治疗后美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及改良Rankin评分量表(modified Rankin scale,mRs)均低于未治疗组,差异有统计学意义(P<0.05);治疗组出血发生率高于未治疗组(P<0.05),且多以轻度血红蛋白下降为主.多因素Logistic分析提示,慢性肾功能不全、胃癌病灶直径≥2cm及T1～T2 分期是合并胃癌的AIS患者服用阿司匹林后并发消化道出血的危险因素.结论 合并胃癌的AIS患者进行阿司匹林抗血小板治疗可有效改善脑血管功能,降低脑神经受损程度,但当该类患者的 T 分期为 T1～T2、合并慢性肾功能不全及胃癌病灶直径≥2cm时易并发消化道出血.
Efficacy and safety of antiplatelet therapy in patients with acute ischemic stroke complicated with gastric cancer
Objective To explore the efficacy and safety of antiplatelet therapy in patients with acute ischemic stroke(AIS)complicated with gastric cancer.Methods Clinical data of 89 patients with AIS complicated with gastric cancer who were hospitalized in the First People's Hospital of Huzhou from January 2018 to October 2022 were retrospectively analyzed.The patients were divided into treatment group(59 cases)and untreated group(30 cases)according to whether they received antiplatelet therapy or not,and the clinical characteristics and prognosis of the two groups were compared.To analyze the clinical features and influencing factors of gastrointestinal bleeding complicated by antiplatelet therapy in AIS patients with gastric cancer.Results The patients in treatment group were younger than those in untreated group,and had more history of antiplatelet therapy,hypertension and cardiovascular disease,the difference was statistically significant(P<0.05).The National Institute of Health stroke scale(NHISS)and modified Rankin scale(mRs)of patients in treatment group were lower than those in untreated group after antiplatelet therapy,the difference was statistically significant(P<0.05).The incidence of bleeding in treated group was significantly higher than that in untreated group(P<0.05),most of the patients had mild hemoglobin decline.Multivariate Logistic analysis suggested that chronic renal insufficiency,gastric cancer lesion diameter≥2cm and T1-T2 stage are risk factors for gastrointestinal bleeding in AIS patients with gastric cancer after taking aspirin for antiplatelet therapy.Conclusion In AIS patients with gastric cancer,aspirin antiplatelet therapy can effectively improve cerebrovascular function and reduce the degree of brain nerve damage.However,when these patients are combined with T1-T2 stage,chronic renal insufficiency and gastric cancer lesion diameter≥2cm,gastrointestinal bleeding is easy to occur.
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