不同剂量降纤酶治疗伴颈动脉粥样硬化的脑梗死

目的 :比较不同剂量降纤酶治疗脑梗死和颈动脉粥样硬化的疗效和安全性。方法 :伴颈动脉粥样硬化的急性脑梗死病人 12 0例 ,分为 3组 ,降纤酶大、小剂量组和对照组 ,各 4 0例。大剂量组予降纤酶 10U ,静脉滴注 (静滴 ) ,隔日一次 ,共 7次 ,总剂量 70U。小剂量组于发病d 1,3,5分别予降纤酶10 ,5 ,5U ,静滴 ,总剂量 2 0U。对照组予低分子右旋糖酐 5 0 0mL +丹参注射液 2 0mL ,静滴 ,qd×14d。结果 :大剂量组总有效率 93% ,高于其他 2组 (均为 78% ) ,血浆纤维蛋白原降幅大于小剂量组(P <0 .0 1)。治疗后 3mo神经功能缺损程度评分 ,大剂量组 (5±s 6 )分 ,小剂量组 (12± 6 )分 (P <0 .0 1)。大剂量组颈动脉粥样硬化斑块面积减小明显 ,脑梗死复发率大剂量组明显低于其他 2组。治疗中未见严重出血情况。结论 :大剂量降纤酶治疗脑梗死和颈动脉粥样硬化疗效肯定 ,且能减少脑梗死的复发 ,无明显不良反应。

Different dose of defibrase in treating cerebral infarction associated with carotid atherosclerosis

AIM: To compare the clinical effects and safety of different dose of defibrase in the treatment cerebral infarction associated with carotid atherosclerosis. METHODS: One hundred and twenty patients with acute cerebral infarction associated with carotid atherosclerosis were divided into three groups (n=40 each group):control group and two defibrase groups with a small and a large dose defibrase. The large dose group was treated with defibrase 10 U, iv, gtt, qod, for seven times and the total dose was 70 U. The small dose group was treated with defibrase 10 U at d 1, 5 U at d 3 and 5 U at d 5, iv, gtt and the total dose was 20 U. The control group was treated with Salvia miltiorrhiza injection 20 mL + dextran 500 mL, iv, gtt, qd for 14 d. The clinical effect, the level of plasma Fg, the neurological function defect scale, the area of carotid atherosclerosis and the recurrent rate in three groups were observed. RESULTS: The total effective rates in treating cerebral infarction were 93 %, 78 % and 78 % in large dose group, small dose group and control group, respectively. The level of plasma Fg in the large dose group ((1.5±s 0.8) g·L -1) was obviously lower after treatment than that in the small dose group ((2.2±0.5) g·L -1), P<0.05. The neurological function defect scales were all obviously decreased 3 mo after treatment in three groups. There were significant difference between large dose group (5±6) and small dose group (12±6). There was no difference between the small dose group and the control group (P>0.05). The area of carotid atherosclerosis was obviously decreased 3 mo after treatment in the large dose group (P<0.01) and it did not change in the other two groups. The recurrent rate of cerebral infarction in the large dose group was obviously lower than that in the other groups (P<0.05). There was no serious bleeding situation during treating with defibrase. CONCLUSION: Large dose defibrase is effective and safe in treating acute cerebral infarction and carotid atherosclerosis, and can decrease recurring rate of cerebral infarction significantly.