尿激酶联合法舒地尔治疗超急性期脑梗死的观察  

Observation of fasudil and urokinase in joint treatment of cerebral infarction

作　　者：邓可[1,2] 

机构地区：[1]湖南师范大学附属岳阳医院 [2]岳阳市二人民医院神经内科,湖南岳阳414000

出　　处：《临床荟萃》2013年第5期512-514,共3页Clinical Focus

摘　　要：目的观察尿激酶联合法舒地尔治疗急性期脑梗死的疗效。方法将91例超急性脑梗死患者分成两组。溶栓组除用抗血小板聚集、扩张血管以及对症治疗以外,用尿激酶100万U加入生理盐水100ml静脉泵输注溶栓治疗1次,后连用14天盐酸法舒地尔30mg加入生理盐水250ml静脉滴注,每天1次。常规组仅用抗血小板聚集、扩张血管以及对症治疗,比较两组入院时及治疗7天后神经功能缺损评分(NIHSS)和临床疗效。结果在入院时NIHSS评分溶栓组明显高于常规组,分别为13分vs 7.5分,治疗7天后溶栓治疗组NIHSS与常规治疗组差异无统计学意义,NIHSS评分4分vs 5分(P>0.05),但溶栓组的显效率高于常规组,58.3%(28/48)vs 4.7%(2/43)(P<0.01)。Logistic回归分析显示患者存在心房颤动病史(OR=0.205,95%CI=0.048～0.867)、入院时血糖值高(OR=0.770,95%CI=0.611～0.971)是导致脑梗死溶栓不成功的危险因素。结论尿激酶联合法舒地尔治疗超急性期脑梗死疗效显著,无明显不良反应。有心房颤动及溶栓前血糖值影响溶栓结局。Objective To observe the urokinase combined with fasudil treatment of the acute phase of cerebral infarction. Methods Ninety-one cases of patients with hyperacute cerebral infarction were divided into two groups, thrombolytic treatment group（ n = 43） except anti-platelet accumulation, dilation of blood vessels, and symptomatic treatment,using urokinase 1 000 000 U added in saline 100 ml intravenous pump infusion thrombolytic therapy for a time,then hydrochloride fasudil 30 mg added in saline 250 ml intravenous drip once daily for 14 days. Conventional group only had anti platelet accumulation, dilation of blood vessels, and symptomatic treatment. NIHSS score and clinical efficacy were compared on admission and 7 days after the treatment between two groups. Results Admission N^IHSS score in thrombolysis group was significantly higher than that in conventional group, 13 scores vs 7. 5 scores （ P 〈0.05）. There were no significant difference of NIHSS after therapy for 7 days between thrombolytic therapy group and conventional treatment group,4 scores vs 5 scores （ P 〈0.05） ,but the clinical efficacy rate of thrombolysis group was significantly higher than that in conventional treatment group 58.3 % （28/48） vs 4.7% （2/43）（ P d0.01）. Logistic regression analysis showed atrial fibrillation history （ OR = 0. 205,95 % CI = 0. 048-0. 867） and admission hyperglycemia （ OR = 0. 770,95 % CI = 0.611-0. 971） in patients were the risk factors leading to unsuccessful cerebral infarction thrombolysis. Conclusion Urokinase combined fasudil treatment of hyperacute cerebral infarction has significant clinical efficacy, without obvious adverse reactions, but atrial fibrillation and serum glucose affect thrombolysis outcome.

关 键 词：脑梗死 尿纤溶酶原激活物 血栓溶解疗法 法舒地尔 心房颤动 

分 类 号：R743.33[医药卫生—神经病学与精神病学]