MRI指导下急性脑梗死降纤治疗规范探讨  

Discussion of Therapeutic Standard by Decreasing Serum Fibrinogen Level in Ireatment of Acute Cerebral Infarction Instructed by MRI

作　　者：谢连红[1] 任传成[1] 孟令平[1] 周亚刚[1] 钱湘绮[1] 余桂军[1] 段磊[1] 倪冬艳[1] 

机构地区：[1]复旦大学附属上海市第五人民医院神经内科,上海200240

出　　处：《中国临床医学》2005年第3期376-379,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨在MRI指导下规范化巴曲酶治疗急性脑梗死的临床疗效及安全性评价。方法:符合人选及排除标准的6-72h内急性脑梗死患者30例,根据本研究制定的规范方案分别接受20-30U的巴曲酶治疗(治疗组),并与同期未接受巴曲酶治疗的30例急性脑梗死患者(对照组)对比研究。分别观察治疗前后的ESS评分、Barthel指数评定、MRI和MRA变化并进行安全性评价。结果:①治疗前治疗组的ESS评分是66.98±16.99,对照组的ESS评分是65.32±16.48,无显著差异(P>0.05);治疗7d后两组的ESS评分分别为77.91±18.62和68.14±17.56(P<0.05);治疗21d后两组的ESS评分分别是84.12±17.18和76.89±19.32(P<0.01);治疗90d后两组的ESS分别为91.76±14.05和80.07±15.90(P<0.01),两组之间具有极显著差异。②治疗前治疗组和对照组的梗死面积分别为3.17±2.87cm2和2.81±2.33cm2(P>0.05)。治疗后治疗组和对照组的梗死面积分别为2.43±2.51cm2和2.70±2.41cm2,治疗组治疗前后梗死面积比较有显著差异(P<0.05),对照组治疗前后梗死面积比较无明显差异(P>0.05)。③在治疗组有4例患者在治疗前MRA显示大脑中动脉(MCA)阻塞,治疗后MRA均显示血管再通。④巴曲酶治疗组无一例并发症发生。结论:在MRI指导下,利用巴曲酶进行急性脑梗死的规范化降纤治疗是安全、有效的。Objective: To discuss the clinical efficacy and safety evaluation of batroxobin in treatment of acute cerebral infarctions according to our therapeutic standard instructed by MRI. Methods: Judged by both the inclusive and exclusive standards, 30 patients attacked acute cerebral infarctions between 6 and 72 hours after symptom onset were selected by using the batroxobin 20-30 U as a test group. At the same time, other 30 patients were also selected as a control group. Both before and after clinical treatment, the change of ESS. Barthel index, MRI and MRA were all observed; furthermore its safety was also evaluated. Results: ① Before clinical treatment, the RSS values of the test and control groups were 66.98 ± 16.99 and 65. 32 ± 16. 48, respectively, no significant difference could be found(P>0. 05); after 7 days treatment, the ESS values were changed to be 77.91 ± 18. 62 and 68. 14 ± 17. 56(P<(). 05); after 21 days treatment, the ESS values were changed to be 84.12 ± 17. 18 and 76. 89 ± 19. 32(P<0. 01)i after 21 days treatment, the ESS values were changed to be 91. 26 ± 14. 05 and 80. 07 ± 15.90, significant difference could be observed (P<0. 01). ② Before clinical treatment, the cerebral infarction areas of the test and control groups were 3. 17 ± 2. 87cm2 and 2. 81 ± 2. 33 cm2,respectively, no significant difference could be found(P>0. 05). After clinical treatment, the areas were changed to be 2. 43 ± 2. 51 cm2 and 2. 70 ± 2. 41 cm2. Significant difference was observed before and after clinical treatment for the test group, on the contrary, no significant difference could be observed for the control group. ③ The MRA results showed that there were MRC blocked for 4 patients before clinical treatment. After clinical treatment, the blocked vessels were reopened up. ④ No any complication was observed for the test group by using batroxobin. Conclusion: It is safe and effective for batroxobin in treatment of acute cerebral infarction by decreasing serum fibrinogen level according to our therapeut

关 键 词：巴曲酶 急性脑梗死 临床疗效 磁共振 

分 类 号：R743.3[医药卫生—神经病学与精神病学]