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目的:探讨重组活化凝血因子(rFⅦa)在脑出血早期血肿再扩大中的临床价值。方法:选择发病6 h内完成头颅CT的64例脑出血患者,随机分为rFⅦa治疗组(rFⅦa组)和未应用rFⅦa组(对照组),rFⅦa组给予40μg.kg-1 rFⅦa静脉推注治疗,对照组常规治疗。两组患者分别在治疗前、治疗24 h后比较血肿变化,同时行格拉斯哥昏迷量表(GCS)评分和美国国立卫生研究院卒中量表(NIHSS)评分,3个月后改良的Rankin量表(mRS)评分以评价转归。结果:24 h后复查头颅CT时rFⅦa组血肿扩大(>33%)4例(12.5%),对照组血肿扩大11例(34.4%),两组比较有显著差异(P<0.05);24 h后rFⅦa组GCS评分较对照组增加(P<0.05),NIHSS评分却明显低于对照组(P<0.05);3个月后两组mRS评分在0～3分的患者所占该组比率分别为84%和59%,两组差异有统计学意义。临床未见有不良反应发生。结论:rFⅦa对于脑出血早期血肿扩大具有明显的抑制作用。
Objective: To investigate the clinical value of recombinant activated clotting factor (rFⅦa) in the re-expansion of hematoma in early stage of cerebral hemorrhage. Methods: Sixty-four patients with cerebral hemorrhage who completed craniocerebral CT within 6 hours after onset were randomly divided into rFⅦa group (rFⅦa group) and rFⅦa group (rfⅦa group), and rFⅦa group (40μg.kg-1 rFⅦa group) , Control group conventional treatment. The changes of hematoma in both groups were compared before treatment and 24 hours after treatment. The scores of Glasgow Coma Scale (GCS), NIHSS (National Institutes of Health Stroke Scale) and the improved Rankin Scale after 3 months mRS) score to evaluate the outcome. Results: After 24 hours, the hematoma of rFⅦa group was enlarged (> 33%) in 4 cases (12.5%) and in 11 cases (34.4%) in control group, there was significant difference between the two groups (P <0.05) The GCS score of rFⅦa group was higher than that of the control group (P <0.05), while the NIHSS score was significantly lower than that of the control group (P <0.05). After 3 months, the scores of patients with mRS score between 0 and 3 were respectively 84% and 59%, the difference between the two groups was statistically significant. No clinical adverse reactions occurred. Conclusion: rFⅦa has a significant inhibitory effect on the early expansion of hematoma in patients with intracerebral hemorrhage.