小剂量尿激酶、低分子肝素钙和奥扎格雷钠联合抗栓治疗急性脑梗死的临床研究

Low-dose urokinase combined with low-molecular weight heparin nadroparin calcium and ozagrel sodium in patients with acute cerebral infarction

目的分析小剂量尿激酶、低分子肝素钙和奥扎格雷钠注射液联合抗栓治疗急性脑梗死的疗效及安全性，以探索一种更为实用、有效和安全的急性脑梗死个体化治疗措施。方法选择佛山市南海区第二人民医院神经内科收治的符合人选标准的急性脑梗死患者100例，按不同治疗时间段分组：A组是自2005年1月至2008年2月收治病例，按照《中国脑血管病防治指南》适应证标准人组，共40例：B组是自2008年3月至2011年6月收治病例，适应证除发病时间在24h内及年龄允许〉75岁外，其余人组标准同A组，共60例。A、B组分别采用标准溶栓治疗方案f大剂量尿激酶1及小剂量尿激酶、低分子肝素钙和奥扎格雷钠注射液联合抗栓治疗。分别在溶栓治疗前，治疗后24h、7d、14d采用美国国立卫生院卒中量表评分（NIHSS）及“临床疗效评定标准”评价患者神经功能恢复状况。结果2组患者在首次溶栓／抗栓治疗后NmSS评分均较治疗前明显降低．差异均有统计学意义f氏0．05）。B组在抗栓治疗后24h、7d、14d的NIHSS评分较A组同时间点明显减少，差异均有统计学意义（P〈0．05）。秩和检验显示B组疗效明显优于A组，差异有统计学意义（P〈0．05）。A组颅内实质性出血率为4例（10．0％），B组为2例（3-3％）。结论小剂量尿激酶、低分子肝素钙和奥扎格雷钠注射液联合抗栓治疗用于急性脑梗死的效果优于大剂量尿激酶溶栓，安全性更好。

Objective To explore an individualized treatment measure enjoying more practical, effective and safe characteristics through evaluating the efficacy and safety of combined medications of low-dose urokinase, low-molecular weight heparin nadroparin calcium and ozagrel sodium in treating patients with acute cerebral infarction. Methods One-hunderd patients with acute cerebral infarction patients were recruited in this trail, and grouped according to different treatment times： Group A （n=40, from January 2005 to February 2008, being selected into the group in accordance with standards of China Guideline for Cerebrovascular Disease Prevention and Treatment） and Group B （n=60, from March 2008 to June 2011, being selected into the group in accordance with indications for onset time within 24 h and allowing age more than 75 years）. Standard thrombolytic therapy （high dose urokinase） was performed on Group A and combined medications of low-dose urokinase, low-molecular weight heparin nadroparin calcium and ozagrel sodium （triple antithrombotic therapy） were performed on group B. National Institute of Health Neurological Deficit Scale （NIHSS） and Evaluation Standard of Clinical Efficacy were used to evaluate the recovery of neurological fimction before treatment and 24 h, 7 and 14 d after treatment. Results NIHSS scores after therapy rapidly decreased in both groups as compared with those before treatment （P〈0.05）. The N1HSS scores of Group B at 24 h, and 7 and 14 d after treatment were significantly decreased as compared with those of Group A （P〈0.05）. The efficacy rate of Group B was significantly higher than that of Group A （P〈0.05）. Intraparenchymal hemorrhage rate was 10.0% （4/40） in Group A and 3.3% （2/60） in Group B. Conclusion Triple antithrombotic therapy is more effective and relatively safer than standard thrombolytic therapy in treatment of patients with acute cerebral infarction.