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目的观察低分子肝素联合纳洛酮治疗进展型脑梗死的临床疗效和安全性。方法共选择90例进展型脑梗死患者,随机分成三组:联合治疗组、对照甲组、对照乙组,每组30例。乙组采用常规治疗;甲组在乙组基础上加用低分子肝素;治疗组在甲组基础上加用纳洛酮,然后分别对三组治疗前、后3、7、14d进行神经功能缺损评分,以及治疗14d后临床疗效评价,并进行血小板、凝血酶原时间、出血时间、纤维蛋白原、肝肾功能、头颅CT监测。结果神经功能缺损改善治疗组明显优于对照甲、乙两组(P<0.01),且于第3天就出现明显改善(P<0.05),2周后临床疗效评价总有效率治疗组96.7%、对照甲组80.0%、对照乙组66.7%,治疗组明显优于甲、乙组(P<0.05),显效率三组分别为83.3%、53.3%、33.3%,治疗组优于甲、乙两组(P<0.05、P<0.01),治疗前后实验监测治疗组、对照甲组纤维蛋白原明显下降(P<0.01,P<0.05),血小板、出血时间,凝白酶原时间,肝肾功能无显著变化。未发现出血及其他并发症。结论低分子肝素联合纳洛酮治疗进展型脑梗死更能有效阻止病情发展,改善神经功能缺损,提高临床疗效,安全性高,副作用小,适合早期应用。
Objective To observe the clinical efficacy and safety of low molecular weight heparin combined with naloxone in the treatment of advanced cerebral infarction. Methods A total of 90 patients with progressive cerebral infarction were randomly divided into three groups: combination therapy group, control group and control group B, with 30 cases in each group. Group B was treated with routine therapy; Group A was given low molecular weight heparin on the basis of Group B; In the treatment group, naloxone was added on the basis of Group A, and then neurological deficit was performed on the 3, 7 and 14 days Score, and 14d after treatment for clinical efficacy evaluation, and platelet, prothrombin time, bleeding time, fibrinogen, liver and kidney function, cranial CT monitoring. Results The improvement of neurological deficit in treatment group was significantly better than that in control group A and B (P <0.01), and obviously improved on the 3rd day (P <0.05). After 2 weeks, the total effective rate of clinical curative effect evaluation group was 96.7% , Control group 80.0%, control group B 66.7%, the treatment group was superior to A, B group (P <0.05), the effective rate of the three groups were 83.3%, 53.3%, 33.3% (P <0.05, P <0.01). Before and after treatment, fibrinogen of the treatment group and the control group were significantly decreased (P <0.01, P <0.05), platelets, bleeding time, prothrombin time, No significant change in function. No bleeding and other complications were found. Conclusion Low molecular weight heparin combined with naloxone in the treatment of advanced cerebral infarction can effectively prevent the progression of the disease, improve neurological deficits and improve clinical efficacy, with high safety and little side effects and is suitable for early application.