系统化抗凝治疗频发短暂性脑缺血发作的对照研究

Treatment of Frequent Transient Ischemic Attack by Systematic Anticoagulation of Heparin

目的探讨普通肝素微量持续静脉泵入治疗频繁发作的颈内动脉系统短暂性脑缺血发作(TIA)的疗效。方法 90例患者随机分为治疗组和对照组,每组45例。治疗组给普通肝素12 500 U加入到生理盐水500 mL中,以40 mL/h[约合18U/(kg.h)]速度用微电脑输液泵持续泵入。对照组采用奥扎格雷钠80mg加入到生理盐水250mL中静脉输注,1次/日;合用阿司匹林100mg口服,每日1次,连用14d。观察治疗后TIA发作停止的时间、例数,复查头颅CT有无脑梗死或脑出血发生。监测治疗前后活化部分凝血活酶时间(APTT)、血小板计数、肝肾功能及牙龈出血、镜下血尿、皮下出血等不良反应。结果两组患者治疗前后活化部分凝血活酶时间、肝肾功能均无明显变化(P>0.05)。治疗组3d内TIA得到完全控制44例,占97.78%,而对照组为34例,占75.56%(χ2=9.615,P=0.002),提示治疗组较对照组控制TIA发作有优势。治疗组发生出血不良事件共6例(13.33%),对照组发生出血不良事件2例(4.44%),经卡方检验无统计学意义(χ2=2.195,P=0.138)。结论普通肝素微量持续抗凝治疗频繁发作的颈内动脉系统TIA可以尽快控制发作,降低进展为脑梗死的风险,与对照组相比出血不良风险没有增加。

Objective To observe the curative effect of continuing venous transfusion of heparin to internal carotid artery system on transient ischemic attack （TIA）. Methods Ninety patients were randomly divided into 2 groups：Treatment group （n=45） treated by heparin and control group （n45） treated by sodium ozagrel with aspirin. After treatment for 14 days,the stop time,number of samples of TIA,occurrence of brain cerebral infarction,and cerebral hemorrhage were observed. The activated partial thromboplastin time （APTT）, platelet （Ph）, hepatic and renal function, gingival bleeding, hematuria and subcutaneous hemorrhage were detec ted. Results There were no statistical significance in APTT,Plt and hepatic and renal function after treatment in two groups com pared that before treatment （P〉0.05）. Following treatment for three days,there were 44 （97.78%） patients stopped attack in treat ment group and 34 （75.56%） patients stopped attack in control group （X2=9.615,P= 0.002）.Therewereno difference in blood events in two groups （X2 =2. 195 ,P=0. 138）. Conclusion Heparin transfusion could stop attack of TIA,and decrease the risk of cer ebral infarction.