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目的 探讨低分子肝素、降纤酶联合治疗进展型脑梗死的临床疗效和安全性。方法 将广东省潮州市中心医院 2 0 0 0 - 0 3～ 2 0 0 4 - 0 5进展型脑梗死全部病例随机分 3组 :治疗组、对照甲组、对照乙组 ,每组各 30例。 3组均个体化常规治疗基础上 ,治疗组应用低分子肝素和降纤酶 ,对照甲组应用低分子肝素 ,对照乙组应用降纤酶 ,连续应用 7d ,进行神经功能缺损评分并评价临床疗效 ,监测血小板计数、凝血酶原时间、纤维蛋白原定量。结果 神经功能缺损改善 ,治疗组明显优于对照甲组、乙组 (P <0 0 1) ,对照甲组 ,乙组间无显著差异 (P >0 0 5 )。治疗后第 2周临床疗效评价总有效率治疗组 96 7%、对照甲组 80 0 %、对照乙组 83 3%。治疗组明显优于对照组甲、乙组 (P <0 0 5 ) ;而显效率 3组分别为 80 0 %、5 3 3%、5 3 3% ,治疗组明显优于对照组甲、乙组 (P<0 0 1) ,对照组间无显著差异 (P >0 0 5 )。 3d、7d、14d后纤维蛋白原前后比较 :治疗组较显著降低 (P <0 0 1) ,血小板、凝血酶原时间前后比较均无显著差异 (P >0 0 5 )。结论 低分子肝素、降纤酶联合治疗进展型梗塞 ,更有效中止病情进展 ,改善神经功能缺损 ,提高临床疗效 ,安全性高 ,副作用小 ,适应早期应用。
Objective To investigate the clinical efficacy and safety of low molecular weight heparin and defibrase in the treatment of advanced cerebral infarction. Methods All cases of progressive cerebral infarction from 2000-2003 in 2004 in Chaozhou Central Hospital of Guangdong Province were randomly divided into three groups: treatment group, control group and control group B, with 30 cases in each group . On the basis of individualized routine therapy, low molecular weight heparin and defibrase were used in the treatment group, low molecular weight heparin in the control group A, and defibrase was used in the control group B for 7 days. The neurological deficit score was evaluated and the clinical efficacy was evaluated , Monitoring of platelet count, prothrombin time, fibrinogen quantitation. Results The neurological deficit was improved. The treatment group was significantly better than the control group A and group B (P <0.01). There was no significant difference between the control group and the group B (P> 0.05). In the second week after treatment, the total effective rate of the clinical evaluation was 96.7% in the treatment group, 80% in the control group and 83.3% in the control group. The treatment group was significantly better than the control group A, B (P <0 05); and markedly effective rate of the three groups were 80 0%, 533%, 533%, the treatment group was significantly better than the control group A, B Group (P <0.01), no significant difference between the control group (P> 0.05). The levels of fibrinogen in the treatment group were significantly lower than those in the control group at 3d, 7d and 14d (P <0.01). There was no significant difference in platelet and prothrombin time (P> 0.05). Conclusions The combination of low molecular weight heparin and defibrase in the treatment of advanced infarction can effectively halt the progression of the disease, improve the neurological deficits and improve the clinical curative effect. It has high safety and little side effects and is suitable for early application.