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目的探讨小剂量尿激酶联合氯吡格雷治疗进展性脑梗死的疗效及安全性。方法 96例进展性脑梗死患者,随机分为观察组和对照组,各48例。两组均给予常规措施和氯吡格雷治疗,在此基础上观察组给予小剂量尿激酶。观察两组治疗5、14 d后美国国立卫生研究院初中量表(NIHSS)评分、14 d改良的Rakin量表(m RS)评分、凝血指标变化情况及不良事件发生率。结果治疗前两组NIHSS评分比较差异无统计学意义(P>0.05),观察组治疗5、14 d后NIHSS评分为(10.6±4.4)、(3.6±2.1)分,对照组分别为(15.9±5.2)、(8.1±3.5)分,比较差异有统计学意义(P<0.05)。治疗后5 d,观察组纤维蛋白原(Fib)含量降低明显,且低于对照组,差异有统计学意义(P<0.05);两组凝血酶原时间(PT)、部分凝血酶原时间(APTT)均延长,但组间比较差异无统计学意义(P>0.05)。两组消化道出血、皮下瘀血斑、非症状性脑出血(出血性脑梗死)、症状性脑出血(脑实质内血肿)发生率比较差异无统计学意义(P>0.05)。结论小剂量尿激酶联合氯吡格雷治疗进展性脑梗死疗效显著,无明显不良反应,值得临床借鉴。
Objective To investigate the efficacy and safety of low-dose urokinase combined with clopidogrel in the treatment of patients with progressive cerebral infarction. Methods 96 patients with progressive cerebral infarction were randomly divided into observation group and control group, 48 cases in each. Both groups were given conventional treatment and clopidogrel treatment, on the basis of observation group given low-dose urokinase. The National Institutes of Health NIHSS score, modified Rakin scale (m RS) score, changes of coagulation index and incidence of adverse events were observed after 5 and 14 days of treatment. Results There was no significant difference in the NIHSS scores between the two groups before treatment (P> 0.05). NIHSS scores of the observation group were (10.6 ± 4.4) and (3.6 ± 2.1) after 5 and 14 days of treatment, respectively, and were 15.9 ± 5.2), (8.1 ± 3.5) points, the difference was statistically significant (P <0.05). The levels of fibrinogen (Fib) in the observation group decreased significantly after 5 days of treatment, and were lower than those in the control group (P <0.05). The prothrombin time (PT), partial prothrombin time APTT) were prolonged, but there was no significant difference between the two groups (P> 0.05). The incidence of gastrointestinal bleeding, subcutaneous bleeding spots, non-symptomatic intracerebral hemorrhage (hemorrhagic infarction) and symptomatic intracerebral hemorrhage (intracerebral hematoma) were not significantly different between the two groups (P> 0.05). Conclusion Low-dose urokinase combined with clopidogrel treatment of progressive cerebral infarction significant effect, no obvious adverse reactions, it is worth learning from.