CAJ | 학술논문

目的分析小剂量尿激酶、低分子肝素钙和奥扎格雷钠注射液联合抗栓治疗急性脑梗死的疗效及安全性,以探索一种更为实用、有效和安全的急性脑梗死个体化治疗措施.方法选择佛山市南海区第二人民医院神经内科收治的符合人选标准的急性脑梗死患者100例,按不同治疗时间段分组:A组是自2005年1月至2008年2月收治病例,按照《中国脑血管病防治指南》适应证标准入组,共40例；B组是自2008年3月至2011年6月收治病例,适应证除发病时间在24h内及年龄允许＞75岁外,其余人组标准同A组,共60例.A、B组分别采用标准溶栓治疗方案(大剂量尿激酶)及小剂量尿激酶、低分子肝素钙和奥扎格雷钠注射液联合抗栓治疗.分别在溶栓治疗前,治疗后24 h、7d、14d采用美国国立卫生院卒中量表评分(NIHSS)及“临床疗效评定标准”评价患者神经功能恢复状况.结果 2组患者在首次溶栓/抗栓治疗后NIHSS评分均较治疗前明显降低,差异均有统计学意义(P＜0.05).B组在抗栓治疗后24h、7d、14d的NIHSS评分较A组同时间点明显减少,差异均有统计学意义(P＜0.05).秩和检验显示B组疗效明显优于A组,差异有统计学意义(P＜0.05).A组颅内实质性出血率为4例(l0.0％),B组为2例(3.3％).结论小剂量尿激酶、低分子肝素钙和奥扎格雷钠注射液联合抗栓治疗用于急性脑梗死的效果优于大剂量尿激酶溶栓,安全性更好.
목적 분석소제량뇨격매、저분자간소개화오찰격뢰납주사액연합항전치료급성뇌경사적료효급안전성,이탐색일충경위실용、유효화안전적급성뇌경사개체화치료조시.방법 선택불산시남해구제이인민의원신경내과수치적부합인선표준적급성뇌경사환자100례,안불동치료시간단분조:A조시자2005년1월지2008년2월수치병례,안조《중국뇌혈관병방치지남》괄응증표준입조,공40례；B조시자2008년3월지2011년6월수치병례,괄응증제발병시간재24h내급년령윤허＞75세외,기여인조표준동A조,공60례.A、B조분별채용표준용전치료방안(대제량뇨격매)급소제량뇨격매、저분자간소개화오찰격뢰납주사액연합항전치료.분별재용전치료전,치료후24 h、7d、14d채용미국국립위생원졸중량표평분(NIHSS)급“림상료효평정표준”평개환자신경공능회복상황.결과 2조환자재수차용전/항전치료후NIHSS평분균교치료전명현강저,차이균유통계학의의(P＜0.05).B조재항전치료후24h、7d、14d적NIHSS평분교A조동시간점명현감소,차이균유통계학의의(P＜0.05).질화검험현시B조료효명현우우A조,차이유통계학의의(P＜0.05).A조로내실질성출혈솔위4례(l0.0％),B조위2례(3.3％).결론 소제량뇨격매、저분자간소개화오찰격뢰납주사액연합항전치료용우급성뇌경사적효과우우대제량뇨격매용전,안전성경호.
[Objective]To explore an individualized treatment measure enjoying more practical,effective and safe characteristics through evaluating the efficacy and safety of combined medications of low-dose urokinase,low-molecular weight heparin nadroparin calcium and ozagrel sodium in treating patients with acute cerebral infarction.[Methods]One-hunderd patients with acute cerebral infarction patients were recruited in this trail,and grouped according to different treatment times:Group A (n=40,from January 2005 to February 2008,being selected into the group in accordance with standards of China Guideline for Cerebrovascular Disease Prevention and Treatment) and Group B (n=60,from March 2008 to June 2011,being selected into the group in accordance with indications for onset time within 24 h and allowing age more than 75 years).Standard thrombolytic therapy (high dose urokinase) was performed on Group A and combined medications of low-dose urokinase,low-molecular weight heparin nadroparin calcium and ozagrel sodium (triple antithrombotic therapy) were performed on group B.National Institute of Health Neurological Deficit Scale (NIHSS) and Evaluation Standard of Clinical Efficacy were used to evaluate the recovery of neurological function before treatment and 24 h,7 and 14 d after treatment.[Results] NIHSS scores after therapy rapidly decreased in both groups as compared with those before treatment (P＜0.05).The NIHSS scores of Group B at 24 h,and 7 and 14 d after treatment were significantly decreased as compared with those of Group A (P＜0.05).The efficacy rate of Group B was significantly higher than that of Group A (P＜0.05).Intraparenchymal hemorrhage rate was 10.0％ (4/40) in Group A and 3.3％ (2/60) in Group B.[Conclusion] Triple antithrombotic therapy is more effective and relatively safer than standard thrombolytic therapy in treatment of patients with acute cerebral infarction.