不同剂量低分子肝素治疗急性脑梗死的疗效观察

Curative effect of different dosages of low molecular weight heparin in the patients with acute cerebral infarction

目的观察不同剂量低分子肝素(LMWH)对急性脑梗死(ACI)患者的疗效。方法按入院先后次序随机将入选的ACI病例分为大剂量组(LMWH5000抗XaIU,3次/d,皮下注射)、中剂量组(LMWH5000抗XaIU,2次/d,皮下注射)、小剂量组(LMWH5000抗XaIU,1次/d,皮下注射)和对照组(阿司匹林100mg,1次/d)。对四组患者治疗前、治疗后第8天进行神经功能缺损程度评分和疗效评定。结果与治疗前比较,四组患者治疗后神经功能缺损评分明显下降(P<0.05或P<0.01),尤以大剂量组为著。大剂量组、中剂量组总有效率高于小剂量组和对照组(P<0.01),但大剂量组与中剂量组之间比较差异无统计学意义(P>0.05)。大剂量组治疗后凝血酶原时间延长、纤维蛋白原降低(P<0.05)。四组治疗前后的血小板计数比较差异无统计学意义(P>0.05)。结论不同剂量LMWH均可改善ACI患者的神经功能和预后。权衡疗效、出血性风险和医疗费用,中等剂量LMWH是较合适的选择。

Objective To observe the curative effect of different dosages of low molecular weight heparin （ LMWH） in patients with acute cerebral infarction （ ACI ）. Methods According to the admission date, all selected patients with ACI were randomly divided into large - dose group （ LMWH 5000 anti - factor Xa iU 3 times a day through subcutaneous injection ） , medium - dose group （ LMWH 5000 IU, twice a day ） , small - dose group （ LMWH 5000 IU, once a day ） and control group （ aspirin 100 mg once a day ）. The neurological impairment score （ NIS ） and curative effect of all the groups were evaluated before treatment and on 8th day after the treatment. Results In all the groups, especially in the large - dose group, the NIS of posttreatment were significantly decreased than those of pretreatment （P 〈 0. 05 or P 〈 0.01 ）. The total effective rate of large - dose group and medium - dose group were higher than those of small - dose group and control group, but no significant difference was found between large - dose group and medium - dose group （ P 〉 0.05 ）. In large - dose group, the prothrombin time was prolonged and the fibrinogen level was decreased after the treatment （ P 〈 0.05 ）. In four groups, there was no significant difference in the blood platelets count between pretreatment and post - treatment （ P 〉 0.05 ）. Conclusions Different dosages of LMWH could effectively improve neurological impairment and the prognosis of patients with ACI. In consideration of curative effect, hemorrhagic risk and expense, medium dosage of LMWH is a more suitable choice for the early treatment of patients with ACI.