降纤酶治疗不同部位急性进展型脑梗死的临床研究

Clinical effect of Defibrase on acute advanced cerebral infarction of different sites

目的 观察国产降纤酶治疗急性进展型脑梗死的临床疗效和对血浆纤维蛋白原(FIB)及凝血酶原时间(PT)指标的影响。方法 采用随机对照的方法,对治疗组30例急性进展型脑梗死患者,于病情加重后立即给予降纤酶10 U/d静脉滴注,连续用3 d。对照组30例给予一般对症治疗。于治疗前后进行临床疗效评定及血浆FIB、PT检测。结果 临床神经功能缺损程度评分及Barthel氏指数评分,治疗组及对照组治疗后(28 d)均有下降,两组比较有显著性差异。两组临床总有效率(基本治愈+显著进步+进步)比较无差异,临床总显效率(基本治愈+显著进步)两组比较亦无差异。治疗组治疗后血浆FIB明显下降,而对照组下降不显著。治疗组治疗后血浆凝血酶原时间延长较对照组有显著差异。两组均未出现出血、过敏等副作用。结论 国产降纤酶通过多重作用机制,能迅速溶解脑血栓,治疗急性进展型脑梗死临床疗效优于对照组,尤其适用于脑叶急性进展型脑梗死患者,且越早用药,疗效越明显,并能降低血浆纤维蛋白原,改善血液高凝状态,安全,无明显副作用。

Objective To investigate the efficacy and safety of Defibrase on acute advanced cerebral infarction of different sites and its effect on serum fibrinogen concentration and prothrombin time. Methods Sixty patients with acute advanced cerebral infarction were randomly divided into two groups: treatment group (n= 30) and control group (n= 30 ). Patients in treatment group were treated with Defibrase injection (10 U/d for three days) and patients in control group were treated with anti - symptomatic and supportive methods. The determinant of clinical effect and examination of serum fibrinogen and prothrombin time were done before and after the treatment. Results Twenty eight days after the treatment, nervous system function impairment index and Barthel index were decreased in both treatment group and control group, and the difference between treatment group and control group was significant ( P < 0.05 ) . There was no significant difference in the total efficacy rate between treatment group and control group ( P > 0.05 ) . Serum fibrinogen concentration in treatment group was significantly lowered but not in control group. Serum prothrombin time level of treatment group was significantly prolonged compared with that of control group. No bleeding or allergy reaction occurred in both groups. Conclusion Defibrase is effective to quickly dissolve cerebral thrombus and decrease the infarction area through multiple mechanisms. So it is more efficient in the treatment of acute advanced cerebral infarction than control therapy, especially at early stage. Defibrase can significantly decrease serum fibrinogen concentration and improve the patients' hypercoagulable status without obvious side effects.