高龄急性脑血栓形成的改良型等容血液稀释疗法的研究

Study on the modified isovolumic hemodilution in treatment of the patients of advanced age with acute cerebral thrombosis

目的 前瞻性对比观察改良型等容血液稀释疗法对高龄老人急性脑血栓形成的疗效 ,并探讨其作用机制。方法 采用随机化配对设计 ,以传统有效的常规药物治疗为对照 ,采用改良型血液稀释术治疗 4 6例高龄急性脑血栓形成患者 ,动态观察两组治疗前后血凝全套指标和血小板聚集率变化、血脂水平、血液流变学 (尤其是红细胞压积 )和微循环变化 ,对比测定脑动脉血流速度和静息心电图QTcd值 ,并临床评估患者神经功能恢复程度。结果 改良型血液稀释术能通过抗凝、抗血小板聚集作用及调脂作用 ,改善血液流变和微循环 ,尤其是能显著降低红细胞压积 ,使患者脑动脉血流速度由 (90± 1.2 )cm/s增至 (97± 2 .1)cm/s ,同时使心肌缺血指标QTcd值由 (4 6 .2± 11.1)ms缩短至 (32 .4± 9.3)ms(P <0 .0 5 ) ,治疗后的总有效率 (93.4 % )显著高于传统的常规药物治疗 (77.8% ,P <0 .0 5 ) ,未见明显不良反应。结论 改良型等容血液稀释疗法机制合理 ,疗效确切 。

Objective To observe the therapeutic efficacy of modified isovolumic hemodilution (MIH) in the patients of advanced age with acute cerebral thrombosis (ACT),and to explore its mechanism.Methods A randomized paired design was utilized.Forty six patients of advanced age with ACT were treated with MIH,and the patients treated with conventional therapy served as control group.The changes in their blood lipids,fibrinogen,blood fluidity,cerebral blood flow and QTcd in ECG were compared.The clinical recovery of neurological function was evaluated by comparison.Results The baseline data in two groups had no statistical difference.MIH could promote the cerebral blood flow [increased from (90±1.2) cm/s to (97±2.1) cm/s] by means of reducing the level of blood lipids and fibrinogen and improving blood fluidity(especially by decreasing the hematocrit,Hct),and the prolonged QTcd caused by myocardial ischemia was corrected [QTcd decreased from (42.6± 11.1 ) ms to (32.4±9.3) ms,[WTBX]P<0.05] simultaneously.As a result,the clinical total effective rate (93.4%) in MIH group was significantly higher than that (77.8%) in control ( simultaneously.As a result,the clinical total effective rate (93.4%) in MIH group was significantly higher than that (77.8%) in control (P<0.05).There was no obvious side effect in both groups.Conclusion MIH has reasonable mechanism and confirmed efficacy and can improve the damaged neurological function effectively in the patients of advanced age with ACT.