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目的探讨不同剂量的尿激酶和低分子肝素联合治疗进展性脑梗死的疗效及安全性。方法将四川省凉山州西昌市人民医院2004年1月至2006年4月收治的进展性脑梗死90例患者随机分3组:治疗1组、治疗2组、对照组,每组各30例。3组均采用吸氧,脱水、降颅压、活血化瘀等治疗之后,治疗1组应用小刑量的尿激酶10万单位静滴,连用7 d,12 h 后用低分子肝素,连用7 d。治疗2组用尿激酶50～150万单位静滴,12 h 后同样给予低分子肝素治疗。对照组用右旋糖酐40、血塞通,同时服阿司匹林0.1 g 连续用10 d,进行神经功能缺损评分并评价临床疗效,治疗组复查头颅 CT。结果神经功能缺损改善,治疗1、2组明显优于对照组(P<0.01),治疗1组2组间差异无显著性(P>0.05),治疗后第10天临床疗效评价总有效率治疗1组90%,治疗2组93%,对照组66%,治疗1、2组明显优于对照组(P<0.01),治疗1、2组之间差异无显著性(P>0.05);而显效率3组分别为73.3%、80.O%、50.0%;治疗2组明显优于对照组(P<0.01),治疗组间差异无显著性(P>0.05)。结论不同剂量尿激酶和低分子肝素联合治疗进展性脑梗死,均能有效终止病情进展,挽救缺血半暗带,改善神经功能缺损,提高临床疗效,安全性高,副反应小,适合早期应用。
Objective To investigate the efficacy and safety of different doses of urokinase and low molecular weight heparin in the treatment of advanced cerebral infarction. Methods Ninety patients with progressive cerebral infarction who were treated in Xichang People’s Hospital of Liangshan Prefecture, Sichuan Province from January 2004 to April 2006 were randomly divided into three groups: treatment group 1, treatment group 2 and control group, with 30 cases in each group. 3 groups were treated with oxygen, dehydration, reducing intracranial pressure, blood circulation and other treatment, the treatment of a group of small doses of urokinase 100,000 intravenous infusion, once every 7 d, 12 h after the use of low molecular weight heparin, 7 d. 2 groups treated with urokinase 50 to 1.5 million units intravenous infusion of low molecular weight heparin after 12 h treatment. Control group, dextran 40, Xuesaitong, taking aspirin 0.1 g for 10 consecutive days for neurological deficit score and evaluate the clinical efficacy of the treatment group reviewed head CT. Results The neurological impairment was improved. The treatment group 1 and 2 were significantly better than the control group (P <0.01). There was no significant difference between the two groups in the treatment group 1 (P> 0.05). On the 10th day after treatment, the total effective rate 1 group 90%, treatment group 2 93%, 66% of the control group, the treatment group 1,2 group was significantly better than the control group (P <0.01), there was no significant difference between the two groups (P> 0.05); Significantly effective in the three groups were 73.3%, 80.O%, 50.0%; treatment 2 was significantly better than the control group (P <0.01), no significant difference between the treatment groups (P> 0.05). Conclusions The combination of different doses of urokinase and low molecular weight heparin in the treatment of progressive cerebral infarction can effectively stop the progression of the disease, save the ischemic penumbra and improve neurological deficits, improve clinical efficacy, high safety, low side effects, suitable for early application .