高龄脑梗死患者超急性期降纤治疗疗效观察

目的：观察降纤酶治疗超急性期高龄脑梗死患者的疗效. 方法：41例年龄超过75岁的高龄超急性期脑梗死患者随机分成两组,降纤酶治疗组19例于入院即刻、入院第3天和第5天分别给予降纤酶10BU、5 BU、5 BU静脉滴注,继予氯吡格雷75 mg每日1次;对照组22例入院后立即予氯吡格雷225 mg口服,第2日给予氯吡格雷75 mg每日1次,记录患者治疗前及治疗后第6天NIHSS评分、纤维蛋白原（Fg）、治疗前及治疗后1个月Barthel指数评分.结果：两组治疗前NIHSS评分、血Fg水平、Barthel指数差异无统计学意义,降纤酶治疗组治疗后NIHSS评分、Fg水平均较对照组降低,Barthel指数较对照组增高（P〈0.05）.对照组有1例因消化道出血停药.结论：降纤酶可明显改善高龄超急性期脑梗死患者神经功能及生活质量,但不增加出血风险.

Clinical observation on defibrination therapy for elderly patients in the super-acute phase of cerebral infarction

Objective： To observe the efficacy of defibination therapy for cerebral infarction in super-acute phase in elderly patients. Methods： Forty-one elderly patients over 75 years suffering from cerebral infarction in super-acute phase were randomly divided into two groups. The treatment group （19 cases） were given defibrase 10 BU,5 BU, 5 BU intravenously at admission, on the 3rd day and the 5 th day after admission, followed by clopidogrel 75 mg orally daily. Patients in the control group （n= 22） were given clopidogrel 225 mg orally immediately after admission, followed by 75 mg clopidogrel daily. In the two groups, the NIHSS scores, fibrinogen （Fg） level before and after treatment,and Barthel index scores of the patients one month after treatment were recorded and compared. Results： There was no significant difference in both the NIHSS scores,blood Fg levels and Barthel index between the treatment group and the control group before treatment. But NIHSS scores, Fg levels of the treatment group were significantly lower than those of the control group, and Barthel index in the treatment group was significantly higher than that of the control group after treatment（P〈0.05）. In the control group,one patient was withdrawn due to gastrointestinal bleeding. Conclusion： Defibrase therapy in super-acute phase of cerebral infarction can improve neurological function and quality of life in elderly patients without increasing the risk of bleeding.