普通肝素微量持续抗凝治疗进展性脑梗死的对照研究

A controlled study on the treatment of acute progressive cerebral infarction by continuous anticoagulationwith small doses of heparin

目的探讨普通肝素微量持续抗凝治疗急性进展性脑梗死的方法。方法采用完全随机、平行对照的前瞻性研究方法，选择急性进展性脑梗死患者351例，按随机数字表法分为3组。A组119例采用普通肝素以18U·kg^-1·h^-1持续24h静脉泵入，并根据每8h活化部分凝血活酶时间（APlTr）的变化调整剂量；B组115例采用普通肝素12500U以18u·kg^-1·h6-1静脉滴注，每日1次；C组117例采用低分子肝素钙5000U皮下注射，每日2次。14d后观察患者的神经功能缺损程度[用美国国立卫生研究院卒中量表（NIHSS）评分]和出血事件（颅内出血、皮下出血、牙龈出血、尿潜血和粪潜血），随访6个月观察复发率及日常生活质量[Barthel指数（BI）]。结果A组总有效率（95．80％）明显高于B组（85．22％）和c组（85．47％），复发率（1．68％）明显低于B组（8．70％）和c组（8．33％），差异均有统计学意义（P〈0．05或P〈0．01）；B组与c组比较差异均无统计学意义（均P〉O．05）。A组BI（89．27±8．56）明显高于B组（72．57±9．77）和c组（71．66±9．37），差异均有统计学意义（均P〈0．01）；B组与C组差异无统计学意义（P〉0．05）。A组患者出血事件发生率（5．88％）高于B组（3．48％）和C组（4．27％），但差异无统计学意义（均P〉0．05）。结论普通肝素微量持续静脉泵入可显著减轻进展性脑梗死患者的神经功能缺损程度，增加治愈好转率，降低复发率，提高患者的远期生活质量，出血风险并未增高。

Objective To discuss the treatment of acute progressive cerebral infarction by continuous antieoagulation with small doses of heparin. Methods A prospective, randomized, and controlled clinical research was conducted. Three hundred and fifty-one patients were randomly divided into three groups. Group A （u = 119 ） was treated with heparin, which was controlled by an infusion pump with a speed of 18 U.kg 1h-1 for 24 hours, and the dosage was regulated according to the changes in activated partial thromboplastin time （APTT） which was determined every 8 hours. Group B （n= 115 ） was treated with intravenous drip of 12 500 U of heparin with a speed of 18 U.kg1- h-1 once a day. Group C （n= 117 ） was treated with 5000 U of low-molecular-weight heparin calcium injection twice a day. After 14 days, nerve function defect according to the National Institutes of Heath stroke scale （NIHSS） score was determined, the adverse events （e.g. intracranial hemorrhage, subcutaneous eeehymosis, gingival bleeding, hematuria and occult blood in stools ） were observed. After 6 months, the recurrence rate and Barthel index （BI） would be determined. Results The total efficiency in group A （95.80%） was significantly higher than that in group B （ 85.22% ） and group C （ 85.47% ）. Recurrence rate in group A （ 1.68% ） was significantly lower than group B （ 8.70% ） and group C （8.33%） with significant differences （P〈O.05 or P〈0.01 ）, while there was no significant difference between group B and group C （both P〉O.05 ）. The BI of group A （ 89.27±8.56 ） was significantly higher than group B （72.57±9.77 ） and group C （71.66±9.37 ） with significant difference （both P〈0.01 ）, while there was no significant difference between group B and group C （P〉0.05）. Adverse event rate in group A （5.88%） was slightly higher than that of group B （3.48%） and group C （4.27%）, but the difference was not significant （both P〉0.05）. Conclusions Continuous infusion of low dosage of heparin could significantly reduce neurologic impairment score in patients with progressive cerebral infarction, increase cure rate, reduce the recurrence rate, and raise the BI of patients, and it dose not increase the risk of intracranial and extracranial hemorrhage.