抗血小板联合抗凝治疗在脑梗死急性期的应用研究

The clinical application of antiplatelet combined with anticoagulation therapy in acute cerebral infarction

目的:探讨阿司匹林抗血小板聚集联合低分子肝素抗凝治疗对脑梗死急性期的疗效和安全性。方法:脑梗死急性期患者95例,随机分为对照组45例和观察组50例。对照组给予口服阿司匹林100 mg,1次/天;观察组加用低分子肝素5 000 U,皮下注射,2次/天,连用5 d。比较2组治疗前后神经功能缺损评分(NIHSS)、日常生活能力和凝血功能变化,并比较2组患者治疗后脑梗死进展率和出血发生情况。结果:2组患者治疗前NIHSS评分和日常生活能力评分差异均无统计学意义(P>0.05);2组患者治疗后第14天,NIHSS评分均较治疗前显著降低(P<0.01),日常生活能力评分均较治疗前明显增高(P<0.01),且观察组患者NIHSS评分降低程度和日常生活能力评分升高程度均显著优于对照组(P<0.01)。2组治疗总有效率差异无统计学意义(P>0.05)。观察组脑梗死进展率为6.0%,低于对照组的22.2%(P<0.05)。2组患者治疗前凝血功能检查指标差异均无统计学意义(P>0.05),治疗后2组各项指标差异均有统计学意义(P<0.01)。2组患者不良反应总发生率差异无统计学意义(P>0.05)。结论:阿司匹林抗血小板联合低分子肝素抗凝治疗急性脑梗死安全有效,值得临床推广。

Objective：To investigate the efficacy and safety of the Aspirin of antiplatelet aggregation combined with low-molecular- weight Heparin （LMWH） of anticoagulation therapy in acute cerebral infarction. Methods： Ninety-five patients with acute cerebral infarction were randomly divided into the control group （45 cases ） and observation group （50 cases ）. The control group were treated with 100 mg of Aspirin by oral once a day, and the observation group were subcutaneously injected with 5 000 U of LMWH twice a day for 5 days based on the control group. The NIH Stroke Scale （NIHSS） score, Barthel Index（BI） and coagulation function between before and after treatment in two groups were compared, the progress rate of cerebral infarction and incidence of hemorrhage between two groups after treatment were compared. Results： The differences of the scores of NIHSS and BI before treatment between two groups were not statistically significant（ P 〉 0.05 ）. Compared before treatment ,the scores of NIHSS and BI in two groups significantly decreased and increased after 14 days of treatment, respectively （P 〈 0.01 ）, and the decreasing degree of NIHSS score and increasing degree of BI score in observation group were better than those in control group （P 〈 0.01 ）. The difference of the total effective rate between two groups was not statistically significant（P 〉0.05）. The progress rate of cerebral infarction in observation group（6.0% ） was lower than that in control group（22.2% ）（P 〈 0.05 ）. The difference of the indicator of blood coagulation function between two groups before treatment was not statistically significant（ P 〉 0.05 ）, but which was statistically significant after treatment（ P 〈 0.01 ）. The difference of the total incidence rate of adverse reactions between two groups was not statistically significant（ P 〉 0.05 ）. Conclusions ：The treatment of acute cerebral infarction with the Aspirin of antiplatelet aggregation combined with low-molecular-weight Heparin of anticoagulation is safe and effective,which is worthy of clinical application.