普通肝素治疗急性脑梗死肝素化的影响因素  

An analysis on influencing factors of heparinization in heparin treatment for cases with acute cerebral infarction

作　　者：王志勇[1] 王利春[1] 陈超[1] 戈杰英[1] 高印生[1] 林树芬[1] 

机构地区：[1]河北医科大学沧州中西医结合临床医学院神经内科,河北沧州060001

出　　处：《中国中西医结合急救杂志》2011年第4期225-227,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省科技计划项目（09276101D-18）

摘　　要：目的探讨普通肝素治疗急性脑梗死时达肝素化的影响因素。方法采用前瞻性研究方法，随机抽取2005年5月至2009年5月应用普通肝素抗凝治疗的398例脑梗死患者的临床资料，对预分析的17种因素如性别、年龄、肝素初始剂量、入院时活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、总胆固醇（TC）、三酰甘油（TG）、空腹血糖、合并冠心病、糖尿病、高血压、吸烟史、饮酒史、平均舒张压、平均收缩压、是否合用奥扎格雷钠、是否合用灯盏花注射液等首先采用单因素分析初步筛选，再对初步筛选有意义的因素进行Logistic多因素回归分析。结果单因素分析结果显示，年龄大、肝素初始剂量大、入院时APTT值小、FIB低、TG低、合并冠心病、不吸烟、不饮酒患者容易达到肝素化（P〈0．05或P〈0．01）。Logistic多因素回归分析显示，肝素初始剂量偏大[优势比（OR）1．071，95％可信区间（95％C，）1．030～1．1153、年龄偏大（OR1．034，95％CI1．012～1．057）、入院时FIB偏低（OR0．525，95％C10．356～0．774）、APTT值偏小（OR0．964，95％C10．936-0．993）、无吸烟史（OR 0．528，95％C10．309-0．903）者容易达到肝素化（P〈0．05或P〈0．01）。结论肝素初始剂量、年龄对肝素化具有正性作用，肝素初始剂量越大，年龄越大越容易达到肝素化；而入院时APTT、FIB和吸烟对肝素化具有负性作用，干扰了肝素化的形成。Objective To investigate the influencing factors of heparinization during heparin treatment for patients with acute cerebral infarction. Methods A prospective method was adopted. The medical records of 398 cases with cerebral infarction treated by heparin anti-coagulation therapy from May 2005 to May 2009 were randomly taken out. Seventeen factors were prepared for the analysis, including sex, age, initial dosages of heparin, activated partial thromboplastin time （APTT）, fibrinogen （FIB）, cholesterol （TC）, triglyceride （TG）, fasting blood glucose, coronary heart disease, diabetes, hypertension, smoking, alcohol drinking, average diastolic blood pressure, average systolic blood pressure, using Aozhagelei or not, using Deng- zhanhua injection （灯盏花流向液） or not. Firstly, a single factor was adopted to be the preliminary screening analysis, and then the Logistic regression analysis was carried out for the meaningful factors found from the preliminary step. Results Univariate analysis showed that elder age, higher initial dosage of heparin, low APTT, low TG, presence of coronary heart disease, no smoking, no alcohol drinking on admission were easily to reach heparinization in such patients （P〈 0.05 or P〈 0. 01）. Logistic regression analysis showed that patients with higher initial dosage of heparin （OR 1. 071, 95M CI 1. 030-1. 115）, elder age（OR 1. 034, 95% CI 1. 012-1. 057）, low APTT on admission （OR 0. 964, 95% CI 0. 936-0. 993）, low FIB （OR O. 525, 95% CI 0. 356-0.774）, no smoking （OR 0. 528, 95% CI 0. 309- 0. 903） were easily to reach heparinization （P〈0. 05 or P〈0. 01）. Conclusion The initial dosage of heparin and age are the factors having positive effect on heparinization, thus the higher the dosage of heparin and the elder the age, the easier to achieve heparinization. However, APTT, FIB and smoking on admission are the factors with negative or interfering effect on heparinization,

关 键 词：普通肝素 脑梗死 急性 肝素化 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R969[医药卫生—临床医学]