不同剂量低分子肝素对脑梗死患者甲襞微循环的影响及疗效观察

目的：观察不同剂量低分子肝素对脑梗死患者甲襞微循环的影响和疗效。方法：按入院的先后随机将入选的CI病例分为大剂量组（LMWH 5000抗XaIU，3次／d，皮下注射）、中剂量组（LMWH 5000抗XaIU，2次／d）、小剂量组（LMWH 5000抗XaIU，1次／d）和对照组（阿司匹林100mg，1次／d）。4组患者治疗前、治疗后第8天检查甲襞微循环，并进行神经功能缺损程度评分和疗效评定。结果：与治疗前比较，4组治疗后神经功能缺损评分、甲襞微循环总分明显下降（P〈0．05或P〈0．01），尤其大剂量组明显。大剂量组、中剂量组总有效率高于小剂量组和对照组（P〈0．01），但大剂量组与中剂量组之间比较没有显著性差异（P〉0．05）。大剂量组治疗后凝血酶原时间延长、纤维蛋白原降低（P〈0．05）。4组治疗前后的血小板计数比较没有显著性差异（P〉0．05）。结论不同剂量LMWH均可改善CI患者的微循环状态，改善其神经功能和预后。权衡疗效和出血性风险，中等剂量LMWH是较合适的选择。

Effectiveness and impact of different dosages of low-molecular-weight heparin on nailfold microcirculation in patients with cerebral infarction

Objective: To observe the curative effect and impact on nailfold microcirculation of different dosages of low-molecular-weight heparin(LMWH) in patients with cerebral infarction(CI).Methods: According to the admitted date,all selected patients with CI were randomly divided into high-dose group(LMWH 5000 anti-factor Xa IU thrice daily through subcutaneous injection),medium-dose group(LMWH 5000 IU,twice daily),low-dose group(LMWH 5000 IU,once daily) and control group(aspirin 100mg once daily).The nailfold microcirculations of 4 study groups were checked before treatment and the 8th day after the treatment,and neurologic impairment score and effectiveness were evaluated at the same time.Results: In all of 4 study groups,especially in the high-dose group,the neurologic impairment score and the nailfold microcirculation score of post-treatment were significantly decreased than those of pretherapy(P<0.05 or P<0.01).The total effective rate of high-dose group and medium-dose group were higher than those of low-dose group and control group,but no significant difference was found between high-dose group and medium-dose group(P>0.05).In high-dose group,the prothrombin time of was prolonged and the fibrinogen level was decreased after the LMWH treatment(P<0.05).In 4 groups, no significant difference was found between the blood platelets count of pretherapy and that of post-treatment(P>0.05).Conclusions: Different dosages of LMWH could effectively improve microcirculation state,neurologic impairment and prognosis of patients with CI.Considering curative effect and hemorrhagic risk of LMWH,medium dosage of LMWH is a suitable preference for the early treatment of patients with CI.