普通肝素间断静脉滴注治疗脑梗死的临床研究  

Clinical study on treatment of cerebral infarction with heparin through intermittent intravenous drip

作　　者：伞勇智[1] 李峰[1] 杨鸣[2] 付英子[1] 孟凛冽[1] 李红丽[1] 

机构地区：[1]哈尔滨医科大学附属第二医院神经内科,150086 [2]齐齐哈尔市第一医院神经内科

出　　处：《中华脑血管病杂志（电子版）》2011年第6期11-16,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：黑龙江省留学归国学者基金(LC06C26);中国博士后科学基金(No.20060390236)科学技术项目支持

摘　　要：目的观察普通肝素间断静脉滴注治疗脑梗死的疗效,并与常规治疗、巴曲酶、低分子肝素进行对比。方法将入院患者按入院先后顺序半随机分为常规治疗组,普通肝素组,巴曲酶组,低分子肝素组,每组200例;记录在该患入院时,入院后第一周,及出院时的神经功能缺损评分分值;记录每个患者的牛津郡社区脑卒中规划分型;仅对于普通肝素及巴曲酶两组进行凝血象监测。结果 (1)第一周及出院时评分差值比较:普通肝素组与其他三组比较均有统计学意义(P<0.05),出院时评分差值巴曲酶组与常规治疗组比较差异有统计学意义(P<0.05);(2)疗效比较(按疗效等级):普通肝素组与常规治疗组及低分子肝素组相比疗效差异有统计学意义,肝素组与巴曲酶组疗效差异无统计学意义;(3)各治疗组出血事件发生率:常规治疗组4%,普通肝素组11.5%,巴曲酶组13.5%,低分子肝素组9%,几乎均为尿隐血及牙龈出血事件,其中常规治疗与其他三组比较差异均有统计学意义(P<0.05);(4)肝素组与巴曲酶组组间APTT值比较及FbgC值比较差异均有统计学意义(P<0.001);(5)各梗死类型间评分差值比较无统计学意义;(6)各梗死类型间疗效比较:腔隙性梗死(LACI)与全前循环梗死(TACI)、部分前循环梗死(PACI)、后循环梗死(POCI)比较差异均有统计学意义;TACI与POCI比较差异有统计学意义。TACI与PACI比较差异无统计学意义;PACI与POCI比较差异无统计学意义;(7)各梗死类型间出血倾向比较:TACI与PACI、POCI、LACI比较差异有统计学意义,PACI与LACI比较有统计学意义;(8)男女间评分差值、疗效、出血倾向比较差异均无统计学意义。结论静脉内使用普通肝素间断静脉滴注较低分子肝素及常规活血类药物有更好的疗效,有助神经功能改善,方法简便,且并不比低分子肝素及巴曲酶具更多的出血风险,相对安全。Objective To observe the effect of heparin in treatment of acute cerebral infarction, and compare with conventional therapy, batroxobin and low molecular weight heparin （LMWH）. Methods All the cases of acute cerebral infarction based on Semi-random method were divided into four groups which separately named conventional therapy, heparin therapy, batroxobin therapy and LMWH therapy with 200 cases in each group; to record NIHSS scores of each patient three times when just on admission,7 days after admission and the day before he left hospital ; to record each patient＇ s Oxfordshire community stroke project （OCSP） type ; only to monitor coagulogram of the second and third group. Results （ 1 ） The comparison of difference in NIHSS scores ： heparin therapy compared with the other three groups has statistics meaning both 7 days after admission and the day before patient left hospital （ P 〈 0.05 ）. There were significances between batroxobin group and conventional group（P 〈 0.05 ） ;（2）The comparison of difference in therapeutic effect： heparin group compared with conventional therapy and LMWH therapy has statistics meaning; （ 3 ） The incidence of bleeding events in each group：4% in conventional therapy, 11.5% in heparin therapy, 13.5% in batroxobin therapy and 9% in LMWH therapy, most of them were conceal Blood in urine or gingival bleeding, conventional therapy compared with the other three groups has statistics meaning（ P 〈 0.05 ） ;（4） The comparison of difference in APTY and difference in FbgC between heparin therapy and batroxobin therapy has statistics meaning; （5） There were no change among difference infarction types when compared NIHSS scores; （6）The comparison of difference in therapeutic effect among infarction types： lacunar infarct（LACI） compared with the other three types has statistics meaning; the comparison between total anterior circulation infaret（TACI） and posterior circulation infarction（POCI） has statistics meaning;there were no

关 键 词：脑梗死 普通肝素 巴曲酶 低分子肝素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]