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目的 前瞻性对比观察改良型等容血液稀释疗法对高龄老人急性脑血栓形成的疗效 ,并探讨其作用机制。方法 采用随机化配对设计 ,以传统有效的常规药物治疗为对照 ,采用改良型血液稀释术治疗 4 6例高龄急性脑血栓形成患者 ,动态观察两组治疗前后血凝全套指标和血小板聚集率变化、血脂水平、血液流变学 (尤其是红细胞压积 )和微循环变化 ,对比测定脑动脉血流速度和静息心电图QTcd值 ,并临床评估患者神经功能恢复程度。结果 改良型血液稀释术能通过抗凝、抗血小板聚集作用及调脂作用 ,改善血液流变和微循环 ,尤其是能显著降低红细胞压积 ,使患者脑动脉血流速度由 (90± 1.2 )cm/s增至 (97± 2 .1)cm/s ,同时使心肌缺血指标QTcd值由 (4 6 .2± 11.1)ms缩短至 (32 .4± 9.3)ms(P <0 .0 5 ) ,治疗后的总有效率 (93.4 % )显著高于传统的常规药物治疗 (77.8% ,P <0 .0 5 ) ,未见明显不良反应。结论 改良型等容血液稀释疗法机制合理 ,疗效确切 ,能有效地改善高龄老人急性脑血栓形成后受损的临床神经功能
Objective To prospectively compare the therapeutic effect of modified isovolemic hemodilution on acute cerebral thrombosis in elderly people and to explore its mechanism. Methods A randomized pairwise design was adopted. Traditional and effective routine drug therapy was used as a control. A total of 46 patients with acute cerebral thrombosis were treated with modified hemodilution. The changes of whole set of blood coagulation index and platelet aggregation were observed before and after treatment. Blood lipid level, hemorheology (especially hematocrit) and microcirculation. The cerebral blood flow velocity and QTcd value of resting electrocardiogram were compared and the degree of neurological function recovery was evaluated clinically. Results Modified hemodilution improved blood rheology and microcirculation through anticoagulation, anti-platelet aggregation and lipid-lowering effect. In particular, hemodilution significantly reduced hematocrit and increased cerebral blood flow velocity from (90 ± 1.2) cm / s to 97 ± 2.1 cm / s, meanwhile, the QTcd value of myocardial ischemia decreased from (42.2 ± 11.1) ms to (32.4 ± 9.3) ms (P <0. 0 5). The total effective rate (93.4%) after treatment was significantly higher than that of the conventional conventional medical treatment (77.8%, P <0.05), and no obvious adverse reaction was found. Conclusion The modified isovolemic hemodilution therapy has a reasonable mechanism and effective curative effect and can effectively improve the impaired clinical neurological function in the elderly with acute cerebral thrombosis