抗凝治疗预防高血压脑出血继发栓塞性疾病的疗效及安全性研究

Research of efficacy and safety of anticoagulant therapy for preventing secondary thromboembolic disease in hypertensive cerebral hemorrhage

目的评估高血压脑出血早期应用抗凝治疗预防继发栓塞性疾病的疗效及安全性。方法选取2013年1月至2014年10月该院收治的40例高血压脑出血患者作为研究对象,采用随机数字表法随机分为对照组和预防组,每组20例。预防组于脑出血早期（3~4 d）应用低分子肝素钙注射液5 000 U/d,皮下注射15 d。对照组给予常规治疗、护理。每天检测两组患者血小板计数和凝血功能,于抗凝治疗后1、7、15 d给予双下肢深静脉彩色超声多普勒检查,对比分析两组患者双下肢静脉血栓发生情况。高度怀疑肺栓塞者需完善D-二聚体、肺部螺旋CT增强扫描、心电图监护等检查。于抗凝治疗后1、5、10 d复查头颅CT。结果预防组患者均未发生下肢静脉栓塞;对照组患者中发生下肢静脉栓塞6例（30%）,位于瘫痪侧3例,位于腘静脉下4例,有症状者2例,症状性肺栓塞1例,经抗凝治疗好转。两组患者血小板计数和凝血功能及再出血等方面比较,差异均无统计学意义（P〉0.05）。预防组患者深静脉栓塞[0（0/20）]及肺栓塞发生率[0（0/20）]明显低于对照组[分别为30%（6/20）、5%（1/20）],差异均有统计学意义（P〈0.05）。结论高血压脑出血患者早期采取抗凝治疗措施预防继发栓塞性疾病安全、有效。

Objective To evaluate the efficacy and safety of early anticoagulant treatment for preventing secondary thromboembolic disease in hypertensive intracerebral hemorrhage. Methods 40 cases of hypertensive cerebral hemorrhage in our hospital from January 2013 to October 2014 were selected as the research subjects and divided into the control group and pre- vention group by using the random number table method, 20 cases in each group. The prevention group used low molecular hep- arin calcium 5 000 U/d by hypodermic injection at the early stage of cerebral hemorrhage （3-4 d ） for 15 d. The control group was given the conventional treatment and nursing. The platelet count and blood coagulation function were daily detected. The color ultrasonic Doppler examination for double lower limbs deep veins was performed on 1,7,15 d after anticoagulation therapy. The vein thrombosis occurrence situation of lower limbs in the two groups was performed the comparative analysis. The patients with highly suspected pulmonary embolism needed to perfect the examinations of D-dimer,lung spiral CT enhanced scanning, electro- cardiogram （EKG） monitoring, etc. The head CT was reexamined on 1,5,10 d after anticoagulation therapy. Results Lower limb venous thrombosis did not occurred in the patients of the prevention group;which occurred in 6 cases （30%） of the control group, 3 cases were in the paralytic side,4 cases were located under the popliteal vein, 2 cases had symptoms, 1 case was symptomatic pulmonary embolism, all cases were recovered after anticoagulation therapy. The two groups had no statistical differences in the aspects of platelet count, blood coagulation function and re-bleeding（P〉0.05 ）. The incidence rate of deep venous thrombosis （DVT） and pulmonary embolism in the prevention group were 0 （0/20） and 0 （0/20） respectively, which were significantly lower than with significantly lower than 30% （6/20） and 5% （1/20） in the control group, the differences were statistically significant （P〈 0.05）. Conclusion Adopting early anticoagulant treatment is safe and effective for preventing secondary thrombosis disease in the patients with hypertension cerebral hemorrhage.