阿替普酶联合肝素治疗高龄急性脑梗死患者的疗效观察

The efficacy of alteplase combined with heparin for acute cerebral infarction in elderly patients

目的探讨阿替普酶联合肝素治疗高龄急性脑梗死患者的临床疗效和安全性。方法将神经内科收治的50例高龄急性脑梗死患者根据是否使用肝素抗凝治疗分为抗凝组(26例)和非抗凝组(24例)。2组均经静脉给予阿替普酶50 mg进行溶栓治疗。抗凝组在溶栓治疗的基础上再给予肝素钠静脉泵人,调整肝素剂量以延长APTT基线值,溶栓治疗3 d后改为口服氯吡格雷和/或阿司匹林;非抗凝组则在溶栓24 h后给予氯吡格雷和/或阿司匹林口服。比较2组溶栓前1 d及溶栓后1 d、7 d、14 d、30 d的NIHSS评分以及发病30 d内症状性脑出血发生率、病死率。结果与溶栓前1 d比较,抗凝组在溶栓后7 d、14 d、30d的NIHSS评分明显降低,且14 d、30 d时低于非抗凝组(p<0.05)。溶栓治疗30d内,抗凝组病死1例(3.8%)、非抗凝组病死1例(4.2%,)(P>0.05)。有出血症状抗凝组3例(11.5%)、非抗凝组3例(12.5%)(P>0.05)。结论阿替普酶联合肝素抗凝治疗高龄急性脑梗死可促进患者神经功能症状的恢复,而且不增加症状性出血的发生率及病死率。

Objective To investigate the clinical effect and safety of alteplase combined with heparin for acute cerebral infarction in the very old patients.Methods 50 acute cerebral infarction elderly patients in neurology department of the hospital were divided into two groups（anticoagulant and non-anticoagulant group） according to whether or not receiving heparin treatment.After admission,all patients were received intravenous thrombolytic therapy with alteplase.The patients in anticoagulant group was intravenously infused with sodium heparin,adjusted the dose to extend the APTT baseline.After 3 days, the patients received oral clopidogrel and/or aspirin instead.While the patients in non-anticoagulant group received oral clopidogrel and/or aspirin after 24h of thrombolytic therapy.By application of statistical methods,treatment efficacy were compared between the two groups,and the two groups’ NIHSS scores changes before and after treatment on 1d,7d,14d and 30d were compared too.Mortality and the symptomatic cerebral hemorrhage within 30 days were assessed.Results There was no statistical difference in NIHSS scores between the two groups before and after 1d of thrombolysis（P 〉0.05）.After thrombolysis, the NIHSS scores at 7d,14d and 30d was less than that of non-anticoagulant group（P 0.05） between the two groups.There were 3 cases in anticoagulant group（11.5%） and 3 cases in non-anticoagulant group（12.5%） showed symptoms of hemorrhage within 30 days, there was no statistically significant difference between the two groups（P 〉 0.05 ）.Conclusion Alteplase combined with heparin therapy for acute cerebral infarction in the very old patients can improve neurological function,but without increasing symptomatic hemorrhage and mortality.