不同剂量低分子肝素钙治疗脑梗死的临床研究

Clinical study on different dose low-molecular-weight heparin in the treatment of acute cererbal infarction

目的观察不同剂量低分子肝素（LMWH）对急性脑梗死患者的治疗效果。方法将84例急性脑梗死患者随机分成大剂量LMWH组（20例）、小剂量LMWH组（15例）和对照组（49例）。观察临床疗效、神经功能缺损评分及治疗前后血浆纤维蛋白原、D-二聚体含量变化。结果大剂量LMWH治疗组总有效率为80％，小剂量组为73．33％，均高于对照组的51．02％（X^2=6．07，P〈0．05）。但大剂量LMWH组与小剂量LMWH组之间比较差异不显著（X^2=1．07，P〉0.05）。不同剂量LMWH治疗组神经功能缺损评分、血浆纤维蛋白原及D-二聚体与对照组比较明显降低（P〈0．05），但大剂量LMWH组与小剂量组差异不显著（P〉0．05）。结论低分子肝素治疗急性脑梗死可明显改善症状，降低血浆D-二聚体水平。

Objective To investigate the effect of low-molecular-weight heparin （LMWH） with different dose in the treatment of acute cerebral infarction. Methods The clinical data of 84 cases of acute cerebral infarction, hospitalized from January 2003 to Februavy 2006, were randomly divided into 3 groups： large dose LMWH group （20 cases）, small dose LMWH group （15 cases） and control group （49 cases）. The plasma fibrinogen and D-dipolymer of patients before and after treatment were determined, and clinical effect and neurologic impairment score were observed at the same time. Results The total effective rates in large dose LMWH group （80%） and small dose LMWH group （73.33%） were significantly higher than that in control group （51.02%） （X^2 = 6.07, P 〈 0.05）, but there was no significantly difference between large dose LMWH group and small dose LMWH group （X^2 = 1.07, P 〉 0.05）. The neurologic impairment score, level of plasma fibrinogen and D-dipolymer in the large and small LMWH group were significantly lower than those in control group （P 〈 0.05）, but there was no significant difference between large dose LMWH group and small dose LMWH group （P 〉 0.05）. Conclusion LMWH is effective for the recovery of neural function, and it can decrease the level of plasma D-dipolymer.