CAJ | 학술논문

目的根据血浆纤维蛋白原(FIB)水平给予不同剂量降纤酶治疗,探讨降纤酶个体化剂量治疗急性脑梗死(ACI)的疗效.方法 60例急性脑梗死(发病72 h内)患者随机分为2组,降纤酶组30例,对照组30例.降纤酶治疗组根据治疗前血浆Fm水平>4 g/L,2-4 g/L,1.3～2 g/L分别给予首剂降纤酶15 U,10 U,5 U,给药后每12 h监测一次血浆FIB水平,当血浆FIB水平>1.3g/L时再次给予降纤酶5U,维持患者血浆FIB水平在0.7-1.3 g/L之间达7 d时间,检测治疗前及治疗7d后血浆凝血酶原时间(PT)、血浆活化部分凝血激酶时间(APTT)、血浆纤维蛋白原(Fg)水平,并在治疗14d后进行神经功能缺损程度评分(CSS)和3个月后日常生活活动(ADL)量表评分,评价临床疗效.结果 (1)治疗7 d降纤酶组血浆PT、APTT延长,Pg下降,与治疗前及对照组比较,差异均有显著性.(2)治疗14 d降纤酶组神经功能缺损程度评分改善,与治疗前及对照组比较,差异均有显著性.(3)临床疗效降纤酶组总有效率80%,对照组总有效率50%,两组比较差异有显著性.(4)治疗后3个月日常生活活动量表评分,两组比较差异无显著性,但(独立+轻度依赖)比例降纤酶组为93.3%,对照组为70.0%,两组比较差异有显著性.(5)治疗期间降纤酶组无颅内外出血,随访3个月无死亡病例发生.结论基于血浆纤维蛋白原水平,应用降纤酶治疗急性脑梗死能快速平稳降低患者血浆纤维蛋白原水平,减少神经功能缺损.提高生活质量.个体化降纤酶治疗安全有效.
목적 근거혈장섬유단백원(FIB)수평급여불동제량강섬매치료,탐토강섬매개체화제량치료급성뇌경사(ACI)적료효.방법 60례급성뇌경사(발병72 h내)환자수궤분위2조,강섬매조30례,대조조30례.강섬매치료조근거치료전혈장Fm수평>4 g/L,2-4 g/L,1.3～2 g/L분별급여수제강섬매15 U,10 U,5 U,급약후매12 h감측일차혈장FIB수평,당혈장FIB수평>1.3g/L시재차급여강섬매5U,유지환자혈장FIB수평재0.7-1.3 g/L지간체7 d시간,검측치료전급치료7d후혈장응혈매원시간(PT)、혈장활화부분응혈격매시간(APTT)、혈장섬유단백원(Fg)수평,병재치료14d후진행신경공능결손정도평분(CSS)화3개월후일상생활활동(ADL)량표평분,평개림상료효.결과 (1)치료7 d강섬매조혈장PT、APTT연장,Pg하강,여치료전급대조조비교,차이균유현저성.(2)치료14 d강섬매조신경공능결손정도평분개선,여치료전급대조조비교,차이균유현저성.(3)림상료효강섬매조총유효솔80%,대조조총유효솔50%,량조비교차이유현저성.(4)치료후3개월일상생활활동량표평분,량조비교차이무현저성,단(독립+경도의뢰)비례강섬매조위93.3%,대조조위70.0%,량조비교차이유현저성.(5)치료기간강섬매조무로내외출혈,수방3개월무사망병례발생.결론 기우혈장섬유단백원수평,응용강섬매치료급성뇌경사능쾌속평은강저환자혈장섬유단백원수평,감소신경공능결손.제고생활질량.개체화강섬매치료안전유효.
Objectives To evaluate the therapeutic effect of individualized defibrase therapy according to the level of plasma fibrinogen (FIB) in patients with acute cerebral infarction (ACI). Methods Sixty patients with ACI (within 72 h after onset) were randomly divided into defibrase group (n=30) and control group (n=30). The patients in defibrase group received intravenous defibrase infusion at different first doses (15, 10, and 5 U) according to plasma FIB level (>4 g/L, 2～4 g/L, and 1.3～2 g/L) before treatment. Plasma FIB was measured every 12 h after the first dose of defibrase, and when plasma FIB was over 1.3 g/L, intravenous infusion of 5 U defibrase was given to maintain plasma FIB within the range of 0.70～1.13 g/L over a period of 7 days. The plasma prothrombin time (PT), activated partial thromboplastin time (APTT) and FIB before and after the 7-day treatment were measured, and the scores of Chinese stroke scale (CSS) after 14 days of treatment and Activity of Daily Living (ADL) after 3 months were recorded. Results After 7 days of treatment, plasma PT and APTT were significantly prolonged lengthened and plasma FIB was lowered in defibrase group. The scores of CSS improved in defibrase group after 14 days of treatment, showing significant difference from those of the control group. The clinical effective rate was 80% in defibrase group, significantly higher than that in the control group (50%). The scores of ADL after 3 months were similar between the 2 groups, but the percentage of independent living and mild dependency was significantly higher in defibrase group (93.3% vs 70.0%). No intracerebral and extracerebral hemorrhage occurred in defibrase group the during treatment, no did death occur after 3 months of treatment. Conclusion Defibrase therapy based on plasma FIB level can rapidly and effectively lower plasma FIB, reduce neurological impairment and improve the quality of life in patients with ACI.