阿司匹林与脑出血

临床流行病学循证报告

流行病与卫生统计学桑灏 1020110112

任课教师：李觉张丽娟一、临床病例

患者，男性，79岁。因“突发右侧肢体无力15小时”入院。

2010年10月22日0点左右患者发现右侧肢体无力，行走欠佳，无明显

头痛、头晕，无恶心、呕吐，无进食困难，自服天丹通络胶囊后觉症状稍有

改善，上午8点来我院急诊，查头颅CT示“两侧大脑深部多发腔梗灶，边

界欠清，最大径约10mm，以左基底节区明显”，予疏血通改善循环，醒脑

静改善脑功能，患者病情稳定。为进一步诊治，故拟“脑梗塞”收治入院。

患者发病以来，二便尚正常，夜眠可，近期体重无明显下降。头颅CT未见

高密度病灶。

既往：有高血压史，规则服药。否认糖尿病、冠心病、房颤史。不嗜烟

酒。年轻时有肛瘘手术史（具体不详），3年前有右下肢骨折手术史，有置

入物，行走基本如常。

体检：BP130/90mmHg。神清，口齿稍欠清，双瞳等大等圆，φ2.5mm，

对光反射（+），右鼻唇沟稍浅，伸舌居中。颈软，四肢肌张力正常，右侧

肢体肌力５0-，左侧肢体肌力５0，腱反射对称，双侧病理征（-），针刺觉对

称，右手指鼻欠佳。

二、临床问题

1.给病人用阿司匹林抗血小板聚集是否会诱发病人脑出血？该病人能否应用阿

司匹林？

2.伴高血压的老年病人脑梗塞后存活率？

三．文献证据检索

（一）检索词：脑梗塞（cerebral infarction）、脑出血（cerebral hemorrhage）、阿司匹林（aspirin）、副作用（adverse effect）

检索策略：”erebral infarction”and”cerebral hemorrhage”and”aspirin”and”adverse effect”

The Cochrane library：1篇

1.Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials

PubMed clinic Queries：相关文献12篇；符合文献：4篇

1.Chen ZM, Sandercock P, Pan HC, Counsell C, Collins R, Liu LS, Xie JX,

Warlow C, Peto R

Indications for early aspirin use in acute ischemic stroke : A combined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Aspirin use and incident stroke in the cardiovascular health study. CHS Collaborative Research Grou p.

Stroke. 2000 Jun;31(6):1240-9.

2.Maggioni AP, Franzosi MG, Santoro E, White H, Van de Werf F, Tognoni

G The risk of stroke in patients with acute myocardial infarction after

thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and The International Study Group. N Engl J Med. 1992 Jul 2;327(1):1-6.

3.Shinohara Y, Nishimaru K, Sawada T, Terashi A, Handa S, Hirai S, Hayashi

K, Tohgi H, Fukuuchi Y, Uchiyama S, Yamaguchi T, Kobayashi S, Kondo K, Otomo E, Gotoh F; S-ACCESS Study Group. Sarpogrelate-Aspirin Comparative Clinical Study for Efficacy and Safety in Secondary Prevention of Cerebral Infarction (S-ACCESS): A randomized, double-blind, aspirin-controlled trial. Stroke. 2008 Jun;39(6):1827-33. Epub 2008 Apr 3.

4.Kronmal RA, Hart RG, Manolio TA, Talbert RL, Beauchamp NJ, Newman

A.Aspirin use and incident stroke in the cardiovascular health study. CHS

Collaborative Research Group. N Engl J Med. 1992 Jul 2;327(1):1-6. NGC: 查的14篇指南，选取其中2篇指南

1. Aspirin for the prevention of cardiovascular disease: U.S. Preventive

Services Task Force recommendation statement. 1996 (revised 2009)

2. Diagnosis and initial treatment of ischemic. 2001 Oct (revised 2009 Jun).（二）检索词：脑梗塞（cerebral infarction）、存活率（survival）

The Cochrane Library

检索策略："cerebral infarction in Keywords and survival in Keywords in Cochrane Central Register of Controlled Trials"

共得相关文献：Cochrane Reviews [0] | Other Reviews [1]| Clinical Trials [44]| Methods Studies [0] | Technology Assessments [0] | Economic Evaluations [2]| Cochrane Groups [0]

符合文献：共3篇

1.Rønning OM, Guldvog B . Stroke units versus general medical wards, I:

twelve- and eighteen-month survival: a randomized, controlled trial. 。

1998

2.Anderson CS, Jamrozik KD, Broadhurst RJ, Stewart-Wynne EG .

Predicting survival for 1 year among different subtypes of stroke.

Results from the Perth Community Stroke Study. 1994

3.Eriksson SE . Differences in the outcome of patients with TIA versus

minor stroke. 1992

PubMed Clinic Queries

检索策略：(cerebral infarction and survival) AND systematic[sb]

Limits Activated: Male, Clinical Trial, Meta-Analysis, Practice Guideline, Randomized Controlled Trial, English, Aged: 65+ years, published in the last 3 years

共得相关文献：All (60) Review (19)Free Full Text (19)

符合文献：共3篇

1．Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension.

Hypertension. 2008 Jan;51(1):55-61. Epub 2007 Nov 26.