急性脑梗死患者的临床治疗方法比较

Clinical Treatment of Acute Cerebral Infarction

目的在一般治疗的基础上观察溶栓疗法及低分子肝素(LMWH)疗法对于急性脑梗死临床治疗疗效,并评价其安全性。方法本研究共分3组,溶栓治疗组(n=65)、LMWH治疗组(n=76)和对照组(n=57),三组均进行了基础治疗,溶栓组静脉滴注尿激酶,LMWH腹部皮下注射LMWH(一天2次,连用治疗10d)。采用改良Rankin量表评分和美国国立卫生院神经功能缺损评分(NIHSS)评分来评价三组病例的治疗情况,分别在治疗前及治疗第21d进行测评,同时观察溶栓组和LMWH在治疗后的不良反应。结果 Rankin量表评分和NIHSS评分:在治疗后21d三组的评分均有所改善,溶栓组和LMWH评分结果均好于对照组(P<0.05),其有效率分别为90.7%和86.7%,高于对照组的63.3%(P<0.05);两种不同治疗方法治疗后其凝血功能与对照组基本一致,不存在统计学差异。三组均没有血小板减少症等副作用的发生。结论溶栓治疗和低分子肝素治疗两种方法治疗急性脑梗死患者疗效基本一致,均好于对照组,具有很好的临床价值。

Objective To observe the efficacy and safety of low- molecular- weight heparin （LMWH） and urokinase thrombolytic in the treatment of acute cerebral infarction. Methods LMWH （n=76）and urokinase thrombolytic（n=65） were given subcutaneously for 10 days to treat patients and there were 57 randomized patients as control. All patients were treated with Rankin and NIHSS and the efficacy in the three groups were assessed at different time points before treatment and at the 21st day after treatment, and the adverse reaction associated with the LMWH treatment and urokinase thrombolytic treatment were observed. Results The results of NIHSS and Rankin of three groups improved at the 21st day after treatment, and NIHSS and Rankin of the treatment group was better than those of the control group （P〈0.05） .The total effective rate was 86.7% in the LMWH and 90.7% in the urokinase thrombolytic treatment group and it was significantly greater than 63.3% in the control group （P〈0.05） .The change of fibrinogen was no significant difference from the control group. No serious complication was found such as bleeding, heparin-induced thrombocytopenia and so on. Conclusion LMWH and urokinase thrombolytic treatment is benefit to patients with Cerebral infarction.