小剂量尿激酶联合奥扎格雷钠治疗急性进展型脑梗死的疗效观察

CURATIVE EFFECT OF LOW-DOSE UROKINASE IN COMBINATION WITH SODIUM OZAGREL IN TREATMENT OF PATIENTS WITH PROGRESSIVE CEREBRAL INFARCTION

[目的]观察小剂量尿激酶联合奥扎格雷钠治疗急性进展型脑梗死的临床疗效及安全性。[方法]将100例脑梗死患者随机分为两组:治疗组50例给予小剂量尿激酶25万u静滴,1次/d,连续10d,同时给予奥扎格雷钠120mg静滴,1次/d,连续10d;对照组给予常规治疗(阿司匹林、川芎嗪、血栓通),1次/d,连续10d。观察两组进展性脑梗死的发生率,治疗前后分别观察两组进展性脑梗死的神经功能缺损评分,梗死灶体积的变化。[结果]治疗组神经功能缺损程度在短期内明显改善,阻止了其病情的恶化,与对照组比较差异有统计学意义(P﹤0.01);治疗组总有效率92.0%,明显优于对照组(56.0%);治疗组进展性脑梗死发生率为8.0%(4/50),对照组为28.0%(14/50),两组比较差异有统计学意义(P﹤0.05);治疗前入院时两组间梗死灶体积比较差异无统计学意义(P﹥O.05),治疗后两组梗死灶进展程度比较差异有统计学意义(P﹤0.01);治疗组纤维蛋白原明显降低,与对照组相比差异有统计学意义(P﹤0.01):PT和APIT较治疗前及与对照组比较明显延长,但在正常范围;治疗组50例中出现颅内出血2例(梗死后出血转换1例、非梗死区出血1例);对照组50例中出现颅内出血2例(均为梗死后出血转换),两组比较差异无统计学意义(P﹥0.05)。[结论]小剂量尿激酶联合奥扎格雷钠治疗急性进展型脑梗死安全有效、并发症少,值得临床推广应用。

[ Objective ] To observe the therapeutic effects and safety of low-dose urokinase in combination with sodium ozagrel for patients with progressive cerebral infarction. [Methods] Patients with acute cerebral infarction were randomly divided into study group （ n = 50） and control group （ n =50）. Patients in study group were given urokinase 250 000 U and sodium ozagrel 120mg by intravenous drip once a day for 10 days. Patients in the control group received a routine treatment for 10 days, including aspirin and Chuanxiongzine and so on. Evaluated the incidence of progressive cerebral infarction and the variation of neurological function deficiency scale and the volumes of cerebral infarction in two groups. [ Results] There was a significant deference in therapeutic effect on neurological improvement between study group and control group （P 〈 0.01 ）. The efficiency in study group and control group was 92.0% and 56.0% respectively. The incidence of progressive cerebral infarction was 8.0% in study group and 28.0% control group, there were still significant differences in two groups （P 〈 0.05）. The volumes of cerebral infarction were not significantly different before treatment, but significant difference after treatment in two groups （P 〈 0.01）. The level of fibrinogen was obviously down in study group and significantly different in two groups （P 〈 0.01 ）. Activated partial thromboplastin time （AFFF） and prothrombin time （PT） were prolonged but in normal range. In study group, there were 2 patients with intracerebral hemorrhage, 1 patient with subcutaneous hemorrhage and 1 patient with hematuria. There were 2 pa- tients with intracerebral hemorrhage in control group. But no significant difference was found in two groups （P 〉 0.05）. [Conclusions] A combination of low-dose urokinase and sodium ozagrel is administered efficaciously and safely in patients with acute progressive cerebral infarction and there is a low complication incidence. It may be highly recommended.