小剂量尿激酶联合降纤酶改善急性脑梗死缺血半暗区的临床观察

Clinical Efficacy of Small Dosage of Urokinase Combined with Defibrase in Treatment of Ischemic Semi-Darkspace in Acute Cerebral Infarction

目的:探讨分次小剂量应用尿激酶联合降纤酶改善脑组织缺血半暗区供血,对急性脑梗死的疗效及其安全性。方法:将150例符合入选条件的病例随机分为3组,治疗组(A组)、降纤酶组(B组)和对照组(C组)。A组用尿激酶加降纤酶,B组用降纤酶,C组用复方丹参注射液及刺五加注射液,3组同时并用脑细胞保护剂。结果:神经功能缺损的恢复,A组高于B组和C组(P<0.01)。头颅CT梗死面积缩小的比例,A组高于B组和C组(P>0.05);新发梗死灶的发生率,A组低于B组和C组(P<0.05)。A组治疗后全血粘度、血浆粘度、纤维蛋白原含量降低,与用药前比较有显著差异(P<0.01);出、凝血时间亦延长,但用药前后比较无显著差异(P>0.05)。C组凝血功能治疗前后变化不明显,A组治疗前后及与C组比较(P<0.01),A组也优于B组(P<0.05)。B组治疗后纤维蛋白原较治疗前明显下降,与C组比较(P<0.01)。结论:分次小剂量尿激酶联合降纤酶可改善急性脑梗死患者缺血半暗区脑组织供血,疗效显著且安全。

Objective：To explore the clinical efficacy and safety of fractional urokinase at small dosage combined with defibrase in improving the ischemic semi-darspace of acute cerebral infarction. Methods：The study patients qualified with the inclusion criteria over the last three years were randomly assigned into three groups： the treatment group （Group A） ,the defibrase group （Group B） and the control group （Group C）. The patients in Group A were given urokinase on top of defibrase;those in Group B were treated with only defibrase;the patients in Group C received compound Salvia Miltiorrhiza injection and Acanthopanaz senticosus injection ; the brain cell protectant was administrated to all the three groups. Results ： With regard to the recovery of neurologic impairment, Group A was better than Group B and C （P 〈 0.01 ） ;Group B better than Group C （P 〈 0.05 ）. With CT scanning, the infracted area was reduced markedly in Group A than in Group B and C ; the incidence of new infarction was lower in Group A than in Group B and C and it was less in Group B than in Group C （P 〈0.05）. In Group A blood viscosity,plasma viscosity,and fibrinogen content dropped significantly after the treatment （P 〈0. 01 ） ;bleeding and coagulation times got prolonged without a significant difference （P 〉 0. 05）. In Group C ,there were no remarkable changes in those parameters, but Group A showed a better outcome than Group B and C （P 〈0.01 and P 〈0.05） ;fibrinogen content in Group B was decreased evidently after the treatment with predominating decline in the 2nd ,4th and 6th day and there was a significant difference between Group B and C （ P 〈 0.01 ）. Conclusions ： Fractional small dosage of urokinase combined with defibrase could improve blood supply to the brain tissue in ischemic semi-darkpace of acute cerebral infartion. The therapeutic effect was notable and safe.