低分子肝素钙、纳洛酮联合应用治疗急性脑梗死的临床观察

The clinical observation of naloxone combined with low-molecular-weight haparin calcium in treating acute cerebral infarction

目的:观察低分子肝素钙、纳洛酮联合应用对急性脑梗死的疗效。方法:将81例急性脑梗死患者随机分成2组,治疗组(48例)用低分子肝素钙0.4ml,脐周交替注射1次/12h,共7d,纳洛酮4mg/d,分2次静脉滴注,共14d。对照组(33例)应用蝮蛇抗栓酶0.75U加入生理盐水250ml静脉滴注,1次/d,共14d,分别观察2组治疗前后血液学改变及临床疗效。结果:治疗组凝血酶原时间、血小板、纤维蛋白原均较治疗前有明显改善,2组治疗后比较,治疗组凝血酶原时间、纤维蛋白原均比对照组有显著改善(分别为P<0.01、P<0.05)。治疗组总有效率及显效率分别为93.7%、72.9%;对照组总有效率及显效率分别为84.9%、51.6%,2组比较差异非常显著(P<0.01)。2组均未发现脑出血。结论:低分子肝素钙、纳洛酮联合应用治疗急性脑梗死,其改善血液流变学及临床疗效方面均优于蝮蛇抗栓酶,且安全,疗效确切。

Objective:To investigate the therapeutic effect of naloxone combined with low-molecular-weight haparin calcium on acute cerebral infraction. Methods:81 patients with acute cerebral infarction were randomly divided into 2 groups. 48 patients in treatment group were treated by 0.4ml low-molecular-weight haparin calcium, once per 12 hours, for a treatment course of 7 days, and naloxone 2mg once twice a day, for 14 days. 33 patients in control group were treated by 0.75U ahlysantinfaretase with normal saline 250ml, intravenous infusion once a day, for 14 days. The hematological changes and clinical effect were observed before and after treatment. Results:The hematological changes including fibrinogen, platelets, prothrombin time were improved after treatment, and the changes of prothrombin time, fibrinogen in treatment group were superior to those of control group ( P <0.01, P <0.05 ). The total effective rate and notable effective rate in treatment group were 93.7% and 72.9%, respectively, and 84.9% and 51.6% in control group, respectively. There was a significant difference between the two groups ( P <0.01). The hemorrhagic cerebral infarction was not found in both groups. Conclusion:Naloxone combined with low-molecular-weight haparin calcium is effective and safe in treating acute cerebral infarction, which is better than ahylysantinfaretase in clinical therapeutic effect and improvement of hematological parameters.