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目的分析脑栓塞合并心房顿抑患者占房颤发生脑栓塞患者的百分率及其预后,探索其抗凝治疗方案,以达到改善预后及减少复发。方法选择急性脑栓塞同时合并心房顿抑患者80例,随机分为两组,治疗组42例,对照组38例。两组一般情况差异无统计学意义。治疗组患者在控制脑水肿,改善循环,促进脑代谢等常规治疗的同时,给予华法林2.5 mg/d,至少4周,然后继续服用24个月。治疗过程中检测凝血系列项目。对照组仅常规治疗同治疗组,不服用华法林,口服阿司匹林100 mg/d。比较两组患者4周后的病死率,致残率及随访24个月的复发率。结果治疗组在治疗4周后,病死率、致残率明显低于对照组,差异均有统计学意义(P<0.01);4周后NIHSS评分、BI评分比较治疗组有明显改善(P<0.05),治疗组患者复发率明显小于对照组,二者差异有统计学意义。结论华法林抗凝治疗房颤疗效显著,虽然存在出血并发症,但在密切监测下应用仍比较安全,值得普及和推广。
Objective To analyze the percentage and prognosis of patients with cerebral embolism with atrial fibrillation in patients with cerebral embolism and atrial fibrillation, and to explore the anticoagulant therapy regimen in order to improve prognosis and reduce recurrence. Methods Eighty patients with acute cerebral embolism combined with atrial fibrillation were randomly divided into two groups: treatment group (42 cases) and control group (38 cases). There was no significant difference between the two groups in general. Patients in the treatment group were given warfarin 2.5 mg / d for at least 4 weeks while controlling conventional treatment such as brain edema, circulation improvement and brain metabolism promotion, and then continued for 24 months. Detection of coagulation during treatment project. The control group only conventional treatment with the treatment group, do not take warfarin, oral aspirin 100 mg / d. Mortality, morbidity and recurrence after 24 months of follow-up were compared between the two groups. Results After 4 weeks of treatment, the mortality and morbidity in the treatment group were significantly lower than those in the control group (P <0.01). After 4 weeks, NIHSS score and BI score were significantly improved in the treatment group (P < 0.05). The recurrence rate of the treatment group was significantly less than that of the control group, the difference was statistically significant. Conclusion Warfarin anticoagulant therapy for atrial fibrillation significant effect, although the presence of bleeding complications, but under close monitoring of the application is still relatively safe, it is worth popularizing and promotion.