肝素预防急性脑梗死尿激酶溶栓后再瘫痪的临床观察  

Clinical effects of heparin on hemiplegia following urokinase thrombolysis for acute ischemic cerebral infarction

作　　者：许南燕[1] 邓宇平[1] 赖崇金 钟柳兴[1] 罗伟良[1] 

机构地区：[1]广东省惠州市中心人民医院神经内科,516008 [2]武警惠州支队卫生队,惠州516000

出　　处：《中华神经医学杂志》2008年第7期737-739,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨急性脑梗死瘫痪患者尿激酶溶栓后肝素持续静脉注射预防再瘫痪的疗效及安全性。方法将36例溶栓成功患者按随机数字表法分成两组，治疗组18例溶栓后即用肝素1000U／h持续静脉注射，监测部分凝血酶原时间（aPTT），调节肝素用量，保持aPTT在正常值1．5-2．0倍之间，连用5d。对照组18例溶栓后24h口服阿司匹林0．1g，1次，d。对两组7d内发生再瘫痪及脑出血的例数，第14天神经功能缺损程度评分（NIHSS）进行统计学比较。结果治疗组再瘫痪0例，无症状脑出血5例；对照组再瘫痪5例，无症状脑出血2例；两组再瘫痪发生率差异有统计学意义，脑出血发生率差异无统计学意义。第14天两组神经功能缺损程度评分差异有统计学意义。结论急性脑梗死肢体瘫痪患者在尿激酶溶栓成功后应用肝素抗凝．维持aPTT在正常值的1．5-2．0倍，对于预防再瘫痪是有效和安全的。Objective To evaluate the clinical effects and safety of heparin injection on hemiplegia following urokinase thrombolysis for acute ischemic cerebral infarction. Methods Fifty-six patients with acute cerebral infarction matched the standards which could be treated with urokinase thrombolysis in our department from January 2004 to January 2008. Among the 56 patients, 36 cases with hemiplegia in 2 h after thrombolysis got their muscle force recover over Ⅲ scale. Then 36 cases were divided into the treated group and control group randomly; 18 cases in the treated group were treated by heparin sodium 1000 U/h intravenously for 5 d. They were monitored for their activated partial thromboplastin time （aPTT） and the injected heparin speed was regulated according to their aPTT to keep their aPTT between 1.5 to 2 times of the control value. The 18 cases in the control group were given oral aspirin 0. l daily, 24 h after thrombolysis. The 2 groups were compared in the case numbers of hemiplegia reoccurrence and cerebral hemorrhage within 7 d and the National Institutes of Health Stroke Scale （NIHSS） scores. Results Though there were 5 cases with asymptomatic hemorrhagic conversion, there was no hemiplegia case again in the treated group. In the control group, 5 cases suffered from hemiplegia again and 2 cases asymptomatic hemorrhagic conversion. There were less cerebral infarction in the treated group than the control group after 14 d by brain CT. The neurological deficit improvement in the treated group was more efficient in the treated group than in the control group in 14 d. Conclusion The application of heparin for the prevention of hemiplegia in the patients with acute cerebral infarction with muscle recovery after urokinase thrombolysis is safe and effective and shows obvious clinical value when their aPTT is remained 1.5-2.0 times of the normal level.

关 键 词：脑梗死 再瘫痪 肝素 溶栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]