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目的:探讨纤维蛋白原、纤维蛋白降解产物、D-二聚体等凝血相关指标在急性缺血性脑卒中(AIS)静脉溶栓前后的改变。方法:选择80例发病后7h静脉内溶栓的急性大脑中动脉供血区AIS病例,观察溶栓前、溶栓后2h、溶栓后24h的凝血相关指标变化。结果:在AIS溶栓治疗中,纤维蛋白原在溶栓后2h较溶栓前降低(P<0.01),溶栓24h后上升(P<0.01),但仍低于溶栓前水平(P<0.05);纤维蛋白溶解产物在溶栓后2h较溶栓前升高(P<0.01),溶栓24h后下降(P<0.01);D-二聚体在溶栓后2h较溶栓前升高(P<0.01),溶栓24h后降低(P<0.01),但仍高于溶栓前(P<0.01);ⅩⅢ因子水平在溶栓24h后明显下降(P<0.01);α2-抗纤溶酶水平在溶栓后2h较溶栓前下降(P<0.01),溶栓24h后上升(P<0.01),但仍低于溶栓前水平(P<0.01);纤溶酶原水平在溶栓后2h较溶栓前下降(P<0.01),溶栓24h后上升(P<0.01),但仍低于溶栓前水平(P<0.01);血小板在溶栓治疗后低于溶栓前,尤其是溶栓24h后(P<0.05)。结论:在AIS溶栓治疗中,纤维蛋白原、ⅩⅢ因子、α2-抗纤溶酶、纤维蛋白溶解酶原、D-二聚体、纤维蛋白降解产物及血小板都发生明显变化,与纤溶作用机制相符。
Objective: To investigate the changes of coagulation related indicators such as fibrinogen, fibrin degradation products and D-dimer before and after intravenous thrombolysis in acute ischemic stroke (AIS). Methods: A total of 80 patients with acute middle cerebral artery (AIS) thrombolysis intravenously at 7h after onset were enrolled in this study. Changes of coagulation related indexes before thrombolysis, 2h after thrombolysis and 24h after thrombolysis were observed. Results: In the thrombolytic therapy of AIS, fibrinogen was decreased 2h after thrombolytic therapy (P <0.01), and increased after thrombolysis 24h (P <0.01), but still lower than that before thrombolysis (P < 0.05). The fibrinolytic products increased at 2h after thrombolytic therapy (P <0.01), and decreased after thrombolytic therapy at 24h (P <0.01) (P <0.01), and decreased after thrombolysis for 24 h (P <0.01), but still higher than that before thrombolysis (P <0.01). The level of factor XIII decreased significantly after thrombolysis for 24 h (P <0.01) Enzyme levels decreased 2h after thrombolysis (P <0.01), and increased after thrombolysis 24h (P <0.01), but still lower than that before thrombolysis (P <0.01). The level of plasminogen in soluble (P <0.01) at 2h after thrombolysis, but increased at 24h after thrombolysis (P <0.01), but still lower than that before thrombolysis (P <0.01). The platelets after thrombolysis were lower than those before thrombolysis , Especially after thrombolysis 24h (P <0.05). Conclusions: Fibrinogen, factor XIII, α2-anti-plasmin, fibrinogen, D-dimer, fibrin degradation products and platelets all undergo significant changes in the thrombolytic therapy of AIS, The mechanism is consistent.