低分子肝素对进展性缺血性脑卒中预防作用的探讨

The preventive role of low molecular weight heparin in progressive ischemic stroke

目的 探讨低分子肝素对进展性缺血性脑卒中的预防作用。方法 将起病在 72小时内的 2 0 3例脑梗死患者随机分成低分子肝素治疗组及常规治疗组。低分子肝素组在常规治疗的基础上加用低分子肝素 0 .4 ml,每日 2次腹部皮下注射 ,连续 5～ 10天。治疗前后检测纤溶酶原和凝血因子 活性及血液流变学各项指标 ,同时对进展性缺血性脑卒中患者的神经功能缺损进行评分。结果 低分子肝素组 11例发生进展性缺血性脑卒中 ,常规治疗组 2 3例 ,两组比较有显著性差异 ( P<0 .0 5 ) ;低分子肝素组发生的进展性卒中其进展的严重程度比常规治疗组轻 ( P<0 .0 1) ;近期预后较常规治疗组好 ( P<0 .0 5 ) ;低分子肝素治疗能明显降低纤溶酶原和凝血因子 活性及血液流变学各项指标。结论 低分子肝素治疗能降低进展性缺血性脑卒中发生率 。

Objective To explore the preventive role of low molecular weight heparin in progressive ischemic stroke.Methods 203 patients with cerebral infarction within 72 hours of the onset were randomly divided into low molecular weight heparin(LMWH) group and routine treatment group.LMWH group was administered subcutaneously twice daily for 5~10 days with 0.4 mL LMWH on the basis of routine treatment. The activities of plasminogen and coagulation factor Ⅹ and the indexes of hemorrheology were measured before and after the treatment, the neurologic function deficits of patients with progressive ischemic stroke were evaluated.Results 11 cases for progressive ischemic stroke were occurred in LMWH group, 23 cases in routine treatment group for progressive ischemic stroke, there was remarkable difference between the two groups( P <0.05).The progressive degree was more severe in the routine treatment group than in LMWH group(P< 0.01 ),the recent prognosis was worse in routine group( P <0.05). The activity of plasminogen and coagulation factor Ⅹ and the indexes of hemorrheology were decreased with the treatment of LMWH.Conclusion LMWH can decrease the incidence of progressive ischemic stroke and improve neurologic function deficit of progressive ischemic stroke.