心肺复苏中使用小剂量尿激酶联合低分子肝素钙对早期脑复苏的疗效观察

Observation of curative effect on earlier brain resuscitation in cardiopulmonary resuscitation with low dose of Urokinase combined with low molecular Heparin

目的探讨心肺复苏(CPR)中使用小剂量尿激酶(UK)联合低分子肝素钙对早期脑复苏的疗效。方法通过对40例心肺复苏成功患者在复苏中有无使用小剂量UK和低分子肝素钙分为治疗组(20例)和对照组(20例),观察两组患者复苏即刻及存活1、3、5 d格拉斯哥昏迷评分(GCS)均数及存活30 d的情况;观察治疗组是否有出血或出血致死情况。结果两组患者复苏即刻及存活1、3 d GCS评分比较差异无统计学意义(t=0.156、0.584、0.209,P>0.05);两组存活5 d GCS评分比较,差异有统计学意义(t=6.024,P<0.001);对照组30 d存活率为10%(2/20),治疗组为40%(8/20),两组比较差异有统计学意义(χ2=4.800,P<0.05)。对照组未见皮下出血或其他脏器出血,治疗组有1例在低分子肝素钙注射部位出现皮下局限性瘀血,未见其他脏器出血。治疗组治疗前后纤维蛋白原比较差异有统计学意义(t=4.348,P<0.001),而血小板计数、凝血酶原时间比较差异无统计学意义(t=1.639、1.449,P>0.05)。结论心肺复苏中使用小剂量UK联合低分子肝素钙治疗的方法安全,可提高患者GCS评分,减轻复苏后早期脑损伤,保护脑功能,最终改善脑复苏患者的预后。

Objective To discuss the curative effect of earlier brain resuscitation in cardiopulmonary resuscitation with low dose of Urokinase（UK） combined with low molecular Heparin.Methods 40 cases of successful recovery patients in cardiopulmonary resuscitation（CPR） were divided into treatment group（20 cases） and control group（20 cases） according to with or without the treatment of small doses of UK combined with low molecular weight Heparin.The mean score of Glasgow coma scale（GCS） in patients with immediate recovery and survival in the first day,third day and fifth day were observed.The rate of survival for 30 days and whether the treatment group died of bleeding or bleeding conditions were also observed.Results The mean score of GCS in patients with immediate recovery and survival in the first day and third day of the two groups were no significant（t = 0.156,0.584,0.209,P〈0.05）.On the contrary,the mean score of GCS in survival in the fifth day of the two groups were significant（t = 6.024,P〈0.001）.The rate of survival for 30 days was 10%（2/20） in the control group.Compared with 40%（8/20） in the treatment group,there was a significant difference（χ2 = 4.800,P〈0.05）.Nobody had subcutaneous bleeding or other organ hemorrhage in the control group.But there was 1 patient who had subcutaneous limit ecchymosis in the injection site of low molecular weight Heparin in treatment group.The difference of fibrinogen between before and after treatment in the treatment group was statistically significant（t = 4.348,P〈0.001）,but there was no significant difference of platelet count and prothrombin time between before and after treatment in this group（t = 1.639,1.449,P〈0.05）.Conclusion It is safe to use low dose of UK combined with low molecular Heparin in cardiopulmonary resuscitation.This method can improve the score of GCS,reduce the brain damage in earlier recovery,protect the brain function and ultimately improve the prognosis of patients with brain recovery.