降纤酶两种方案治疗急性脑梗死患者的疗效分析

Therapeutic effect of two defibrase methods on acute cerebral infarction

目的 应用两种不同方案 (不同剂量及时间窗 )进一步评价国产降纤酶治疗急性脑梗死的疗效和安全性。方法 对 1998年 2月至 2 0 0 2年 10月符合入选标准的 72例急性脑梗死患者进行前瞻性对照研究。A组发病在 2 4小时内 ,降纤酶总量 2 0u ,按 10∶5∶5给药 (A方案 ) ,B组发病在 12小时内 ,降纤酶总量 35u ,按 15∶5∶5∶5∶5给药 (B方案 )。结果 A、B两种方案均能降低纤维蛋白原 ,延长凝血酶原时间 ,A、B两方案比较 ,B方案降纤效果更明显 (P <0 0 5 ) ;第 14天神经功能缺失程度改善及 3个月的日常生活能力改善A、B两方案比较无显著性意义 (P >0 0 5 ) ,B方案中因出血等原因而终止治疗的死亡病例数有增加 ,差异有显著性意义 (P <0 0 5 ) ;A、B两种方案对肝肾功能无明显影响。结论 降纤酶确能降低纤维蛋白原 ,延长凝血酶原时间 ,增加剂量及缩短时间窗 ,降纤疗效较好 ,但增加剂量因出血等原因而终止治疗的死亡病例数有增加 ,降纤酶的安全性下降是否与增加剂量有关 。

Objective To investigate the efficacy and safety of two defibrase methods in the treatment of acute cerebral infarction.Methods Seventy-two patients with aute cerebral infarction were allocated to group A and B.Group A were treated with 20 u defibrase within 24 hours by 10∶5∶5 method(method A),Group B were treated with 35 u defibrast within 12 hours by 15∶5∶5∶5∶5 method (method B).Results Both methods had the effect of plasma fibrinogen(FIB) reduction and prothrombin time(PT)prolongation.The effect of method B was more obvious than method A(P<0.05).Both methods showed improved nerve function 14 days after treatment and Barrthel indexes also improved in 12 weeks of follow-up.The death rate was higher treated by method B than method A because by method B bleeding impeded treatment(P<0.05).Both methods had no influence on liver and kidney function.Conclusion Defribrase has the effect of FIB reduction and PT prolongation.It can efficiently decrease FIB by additive dosage,but the death rate caused by bleeding also increases.Whether the safety reduction of defibrase in the treatment of acute cerebral infarction is related to the dosage needs further study.