脑梗死患者血浆D-二聚体变化及低分子肝素钙干预治疗研究

Study of Changes of Blood Plasma D-dipolymer Level and Treatment of Patients with Acute Cerebral Infarction with Low-molecular-weight Heparin Calcium

目的:探讨脑梗死患者血浆纤维蛋白原、D-二聚体变化及低分子肝素钙(LMWHCa)干预治疗的影响。方法:将52例急性脑梗死患者随机分成治疗组和常规治疗组。①常规治疗组:给予复方丹参注射液16 ml加入5%葡萄糖500 ml内,ivd qd,20%甘露醇125 ml,q8h,胞磷胆碱0．5 g,qd,及对症治疗;②治疗组:除予上述治疗外,另给予LMWHCa,2850 AXaIU,q12h,腹壁前外侧皮下注射,疗程10 d。观察临床疗效、治疗前后血浆纤维蛋白原、D-二聚体含量变化。同时检测15例正常对照组血浆纤维蛋白原、D-二聚体含量。结果:急性脑梗死组血浆中D-二聚体与纤维蛋白原含量比正常对照组明显增高(P＜0．01)。临床疗效分四个等级:基本痊愈、显效、好转、无效,两组疗效比较(P＜0．01)。LMWHCa治疗组总有效率79．17%,常规治疗组53．57%(P＞0．05)。治疗后血浆纤维蛋白原、D-二聚体含量较治疗前均有下降(P＜0．05)。结论:急性脑梗死患者存在的凝血纤溶系统异常,经低分子肝素治疗,可明显改善症状,降低血浆D-二聚体水平。

Objective： To investigate the changes of fibrinogen and D- dipolymer level in blood plasma and the effect of the treatment of patients with acute cerebral infarction（ACI） with low-molecular-weight heparin calcium（ LMWH- Ca）. Method： The clinical data of 52 cases with ACI, hospitalized during 2003.6 -2005.12,were randomly divided into the conventional therapy group （28 cases treated with Danshen injection 16 ml and 5% glucose injection 500ml ivd qd, 20% mannitol injection 125 ml, iv q8h, citicoline 0.5 qd, plus symptomatic treatment） and the LMWHCa treatment group （24 cases treated with the above therapy plus LMWHCa 2850 A X aIU, ql2h, hypodermic injection in lateral abdominal wal, for 10d）. The changes in the level of the fibrinogen and D-dipolymer in plasma before and after the treatment and clinical effect of patients with ACI were observed. The level of the fibrinogen and D- dimer in plasma in the controlled group （15 cases）were examined at the same time. Result： The levels of the fibrinogen and D-dipolymer in plasma in patients with ACI were significantly higher than those in the controlled group（ P 〈0.01 ）. The clinical therapeutic effect, including fundamental recovery, was obviously improved. The improvement and inefficacy were significant（ P 〈0.01 ）. The total effective rate （53.57%） was not markedly different（ P 〉 0.05 ）. The level of fibrinogen and D- dimmer in plasma was significantly lower than that before the treatment with LMWHCa（ P 〈 0.05 ）. Conclusion： There were some abnormalities in the coagnlative and fibrinolytic system in patients with ACI. LMWHCa is effective and good for the recovery of neural function, and can decrease the level of plasma D-dipolymer of patients.