CAJ | 학술논문

目的探讨普通肝素微量持续抗凝治疗急性进展性脑梗死的方法.方法采用完全随机、平行对照的前瞻性研究方法,选择急性进展性脑梗死患者351例,按随机数字表法分为3组.A组119例采用普通肝素以18 U·kg-1·h-1持续24 h静脉泵入,并根据每8h活化部分凝血活酶时间(APTT)的变化调整剂量；B组115例采用普通肝素12 500 U以18U·kg-1·h-1静脉滴注,每日1次；C组117例采用低分子肝素钙5000U皮下注射,每日2次.14d后观察患者的神经功能缺损程度[用美国国立卫生研究院卒中量表(NIHSS)评分]和出血事件(颅内出血、皮下出血、牙龈出血、尿潜血和粪潜血),随访6个月观察复发率及日常生活质量[ Barthel 指数(B1)].结果 A组总有效率(95.80％)明显高于B组(85.22％)和C组(85.47％),复发率(1.68％)明显低于B组(8.70％)和C组(8.33％),差异均有统计学意义(P＜0.05或P＜0.01)；B组与C组比较差异均无统计学意义(均P＞0.05).A组B1(89.27±8.56)明显高于B组(72.57±9.77)和C组(71.66±9.37),差异均有统计学意义(均P＜0.01)；B组与C组差异无统计学意义(P＞0.05).A组患者出血事件发生率(5.88％)高于B组(3.48％)和C组(4.27％),但差异无统计学意义(均P＞0.05).结论普通肝素微量持续静脉泵入可显著减轻进展性脑梗死患者的神经功能缺损程度,增加治愈好转率,降低复发率,提高患者的远期生活质量,出血风险并未增高.
목적 탐토보통간소미량지속항응치료급성진전성뇌경사적방법.방법 채용완전수궤、평행대조적전첨성연구방법,선택급성진전성뇌경사환자351례,안수궤수자표법분위3조.A조119례채용보통간소이18 U·kg-1·h-1지속24 h정맥빙입,병근거매8h활화부분응혈활매시간(APTT)적변화조정제량；B조115례채용보통간소12 500 U이18U·kg-1·h-1정맥적주,매일1차；C조117례채용저분자간소개5000U피하주사,매일2차.14d후관찰환자적신경공능결손정도[용미국국립위생연구원졸중량표(NIHSS)평분]화출혈사건(로내출혈、피하출혈、아간출혈、뇨잠혈화분잠혈),수방6개월관찰복발솔급일상생활질량[ Barthel 지수(B1)].결과 A조총유효솔(95.80％)명현고우B조(85.22％)화C조(85.47％),복발솔(1.68％)명현저우B조(8.70％)화C조(8.33％),차이균유통계학의의(P＜0.05혹P＜0.01)；B조여C조비교차이균무통계학의의(균P＞0.05).A조B1(89.27±8.56)명현고우B조(72.57±9.77)화C조(71.66±9.37),차이균유통계학의의(균P＜0.01)；B조여C조차이무통계학의의(P＞0.05).A조환자출혈사건발생솔(5.88％)고우B조(3.48％)화C조(4.27％),단차이무통계학의의(균P＞0.05).결론 보통간소미량지속정맥빙입가현저감경진전성뇌경사환자적신경공능결손정도,증가치유호전솔,강저복발솔,제고환자적원기생활질량,출혈풍험병미증고.
Objective To discuss the treatment of acute progressive cerebral infarction by continuous anticoagulation with small doses of heparin.Methods A prospective,randomized,and controlled clinical research was conducted.Three hundred and fifty-one patients were randomly divided into three groups.Group A (n = 119) was treated with heparin,which was controlled by an infusion pump with a speed of 18 U ·kg-1 ·h-1 for 24 hours,and the dosage was regulated according to the changes in activated partial thromboplastin time (APTT) which was determined every 8 hours.Group B ( n= 115) was treated with intravenous drip of 12 500 U of heparin with a speed of 18 U·kg-1·h-1 once a day.Group C (n= 117) was treated with 5000 U of low-molecular-weight heparin calcium injection twice a day.After 14 days,nerve function defect according to the National Institutes of Heath stroke scale (NIHSS) score was determined,the adverse events (e.g.intracranial hemorrhage,subcutaneous ecchymosis,gingival bleeding,hematuria and occult blood in stools) were observed.After 6 months,the recurrence rate and Barthel index (BI) would be determined.Results The total efficiency in group A (95.80％ ) was significantly higher than that in group B? ( 85.22％ ) and group C ( 85.47％ ).Recurrence rate in group A ( 1.68％) was significantly lower than group B ( 8.70％ ) and group C ( 8.33％ ) with significant differences (P＜0.05 or P＜0.01 ),while there was no significant difference between group B and group C (both P＞0.05 ).The BI of group A (89.27 ± 8.56) was significantly higher than group B (72.57 ± 9.77) and group C (71.66 ±9.37) with significant difference (both P＜0.01 ),while there was no significant difference between group B and group C (P＞0.05 ).Adverse event rate in group A (5.88％ ) was slightly higher than that of group B (3.48％ ) and group C (4.27％ ),but the difference was not significant (both P＞0.05 ).Conclusions Continuous infusion of low dosage of heparin could significantly reduce neurologic impairment score in patients with progressive cerebral infarction,increase cure rate,reduce the recurrence rate,and raise the BI of patients,and it dose not increase the risk of intracranial and extraeranial hemorrhage.