急性脑梗死阿替普酶静脉溶栓后血管再闭塞应用低分子肝素钙的价值

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摘要目的探讨低分子肝素钙对急性脑梗死阿替普酶静脉溶栓后血管再闭塞患者的应用价值。方法收集2010-2014年上海市同仁医院神经内科收治的经阿替普酶静脉溶栓后血管再闭塞的44例急性脑梗死患者资料,根据是否采用低分子肝素钙,分为抗凝组和对照组,抗凝组23例,对照组21例。评价两组治疗后1、14、90 d的疗效,包括神经功能缺损评分(NIHSS)及mRS评分,同时观察90 d内再脑出血发生率及病死率。结果抗凝组和对照组14 d总有效率分别为78.3%、42.9%,差异有统计学意义(P＜0.05);90 d mRS评分分别为2.00±1.51、3.10±1.76,差异有统计学意义(P＜0.05)。抗凝组和对照组脑出血(症状性脑出血+非症状性脑出血)发生率分别为17.4％、14.3％,病死率分别为8.7%、9.5％,两组比较,差异均无统计学意义。结论低分子肝素钙治疗阿替普酶溶栓后血管再闭塞,可改善患者神经功能,效果满意。

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	朱立勋
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关键词 ：急性缺血性卒中, 阿替普酶, 溶栓, 再闭塞, 低分子肝素钙

Abstract：Objective To study application value of the low molecular weight heparin calcium in re-occlusion patients in the process of thrombolysis with alteplase. Methods Forty-four patients with acute cerebral infarction admitted into this hospital in 2010-2014 were divided into observation group(n=23) and control groups(n=21).The former received low molecular weight heparin calcium combined with alteplase.The outcome scores were evaluated according to the National Institute of Heath Stroke Scale(NIHSS) before treatment and 1 d, 14 d after thrombolysis,the modified Rankin Scale (mRS) score after thrombolysis 90 d were observed,and the mortality, hemorrhagic transformation as the safety indicators were evaluated. Results There were significant differences in efficacy outcome rate (78.3%, 42.9%, respectively) between the two groups at 14 days (P<0.05). There were no significant differences between the two groups in the incidence of mortality and cerebral hemorrhage (symptomatic and non-symptomatic intracerebral hemorrhage) at 90 d. There were significant differences between the two groups at 90 d in mRS score (2.00±1.51, 3.10±1.76, respectively,P<0.05). Conclusions The treatment of the low molecular weight heparin calcium combined with alteplase in patients with aggravation of signs and symptoms in the process of thrombolysis can improve neurological function with satisfactory results.

Key words： acute cerebral infarction alteplase thrombolysis re-occlusion low molecular weight heparin calcium

收稿日期: 2015-02-20

ZTFLH:

R743.3

通讯作者: 陆学胜,E-mail:lxssh@126.com

作者简介: 朱立勋,硕士,主治医师,E-mail:zhulixun2011@sina.com

引用本文:

朱立勋, 耿瑞慧, 陆学胜, 李克良, 丁素菊. 急性脑梗死阿替普酶静脉溶栓后血管再闭塞应用低分子肝素钙的价值[J]. 武警医学, 2015, 26(6): 555-557. ZHU Lixun, GENG Ruihui, LU Xuesheng, LI Keliang, DING Sujv. Application value of low molecular weight heparin calcium in treatment of re-occlusion patients in process of thrombolysis with alteplase. Med. J. Chin. Peop. Armed Poli. Forc., 2015, 26(6): 555-557.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2015/V26/I6/555

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