不同剂量低分子肝素治疗急性脑梗死的疗效及安全性比较

将同期收治的113例急性脑梗死（ACI）患者随机分为肝素大剂量组28例、中剂量组25例、小剂量组30例和对照组30例。肝素大、中、小剂量组均予低分子肝素（LMWH）5000IU腹壁皮下注射，分别为3次／d、2次／d和1次／d；对照组口服阿司匹林100mg，1次／d。治疗1周后观察疗效。结果肝素大、中、小剂量组间总有效率无显著差异，但均显著高于对照组（P均〈0．01）；肝素大剂量组凝血酶原时间延长、纤维蛋白原降低（P〈0．05）。认为不同剂量LMWH均可改善ACI神经功能和预后，但中等剂量LMWH较为安全。     

不同时间窗低分子肝素对脑梗死患者甲襞微循环的影响

目的观察低分子肝素（LMWH）在不同时间窗对脑梗死（CI）患者甲襞微循环的影响及疗效。方法按起病至治疗开始时间分为〈24h组、24～48h组、49h～7d组。3组患者均使用LMWH 5000抗XaIU腹壁皮下注射，2次／d，共7d，于治疗前、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，3组患者治疗后甲襞微循环总分均明显下降（P〈0．05或P〈0．01），尤以〈24h组为著，但3组治疗前后差值比较无显著差异；3组患者治疗后的神经功能缺损评分均降低（P〈0．05），治疗前后神经功能缺损评分差值比较有显著差异（P〈0．05），〈24h组大于49h～7d组（P〈0．01）。结论LMWH在不同时间窗均可改善CI患者的微循环状态和神经功能缺损程度，其疗效以24h内为佳。     

低分子肝素对脑梗死患者甲襞微循环的动态影响及疗效观察

目的观察低分子肝素(Low molecular weight heparin,LMWH)对脑梗死(Cerebral infarction,CI)患者甲襞微循环的动态影响和疗效。方法按入院的先后随机将入选的CI病例分为LMWH组和对照组。LMWH组(n=25)予LMWH5000抗XaIU腹壁皮下注射,2次/d,共7d;对照组(n=30)予阿司匹林肠溶片口服,100mg/d。LMWH组患者分别于LMWH注射前和治疗后1h、2h、3h、4h、5h、6h、7h、治疗后第8天检查甲襞微循环,对照组分别于治疗前和治疗后第8天检查甲襞微循环。两组患者治疗前、治疗后第8天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,LMWH组治疗后2h～5h甲襞微循环总积分明显下降(P<0.01),尤其以治疗后3h最明显。LMWH组、对照组的总有效率88%和60%,两者差异有统计学意义(P<0.05)。两组治疗前后的神经功能缺损评分、甲襞微循环总分对比差异有统计学意义(P<0.05或P<0.01),LMWH组治疗前后神经功能缺损评分、甲襞微循环总分减分率分别为0.60±0.33和0.32±0.26,两者呈正相关(r=0.47,P<0.05)。结论LMWH可有效改善CI患者的微循环状态,改善其神经功能和预后,是CI早期治疗的有效手段之一。     

低分子肝素治疗急性脑梗死170例疗效观察

20世纪80年代,肝素亦用于治疗发病2个月内的短暂性脑缺血发作(TIA)和大多数缺血性脑卒中.但近年来的国际多中心试验和循证医学的论证认为,肝素治疗,除在预防静脉血栓、肺栓塞和心源性梗死治疗中应当推荐外,而急性脑梗死的治疗未见有肯定疗效[1].国内用低分子肝素治疗急性脑梗死取得显著疗效[2].本研究回顾分析2003年4月-2005年3月应用低分子肝素治疗急性脑梗死170例,现报道如下.     

低分子肝素治疗进展型脑梗死的临床观察

目的探讨低分子肝素对进展型脑梗死的临床疗效及安全性.方法观察60例进展型脑梗死病人治疗过程中神经功能恢复情况及副反应.结果应用低分子肝素治疗进展型脑梗死总有效率91.7%,对照组总有效率60.0%,且治疗过程中未发生严重不良反应.结论低分子肝素治疗进展型脑梗死安全有效,副反应少.     

低分子肝素治疗急性脑梗死疗效观察

20 0 0年 8月至 2 0 0 2年 7月 ,我院应用低分子肝素治疗急性脑梗死 4 0例 ,并对疗效进行了观察。现报告如下。临床资料 :脑梗死患者 76例 ,起病均在 4 8小时内 ,经头颅 CT检查确诊并排除颅内出血或出血性梗死。均无血液系统疾病 ,血小板 (PL T) >6 0× 10 9/ L。随机分两组 ,治疗组 4 0例 ,男 2 8例、女 12例 ,年龄 37～ 72岁、平均 (6 1.5 2± 5 .35 )岁。根据全国第四届脑血管疾病会议通过的“脑卒中患者临床神经功能缺损程度评分标准”,分为轻度 5例、中度 30例、重度 5例。对照组 36例 ,男 2 9例、女 7例 ,年龄 4 1～ 75岁、平均(6 …     

不同时间窗低分子量肝素治疗对急性脑梗死脑血流量的影响

目的　研究不同时间窗低分子量肝素治疗急性脑梗死的疗效及其对患者脑血流量和脑电图的影响。方法　将 5 0例发病 12小时以内的急性脑梗死患者随机分为治疗A组和对照A组各 2 5例 ;将 60例发病 12小时～ 48小时的患者随机分为治疗B组和对照B组各 3 0例。以上各组均予以丹参注射液 2 0ml+ 0 .9%氯化钠注射液 2 5 0ml,静脉滴注 ,每日 1次。治疗组加用低分子量肝素 410 0IU皮下注射 ,每 12小时 1次。 4组疗程均为 10天。治疗前后均测定脑血流量和脑电图。结果　治疗 4周后 ,治疗A组和对照A组有效率分别为 88%和 5 6% ,经Ridit分析 ,P <0 .0 1;治疗B组和对照B组分别为 63 %和 40 % ,经Ridit分析 ,P <0 .0 1;治疗A组和治疗B组比较 ,经Ridit分析 ,P <0 .0 5。脑血流量和脑电图虽各组均有所改善 ,但以治疗组明显 ,治疗A组尤佳。结论　低分子量肝素能有效治疗急性脑梗死 ,改善患者脑血流量和脑功能 ,尽早应用效果尤为明显。     

低分子肝素钙治疗脑梗死35例疗效观察

目的探讨低分子肝素钙治疗脑梗死的疗效。方法观察35例急性脑梗死应用低分子肝素钙治疗与35例常规治疗神经功能变化比较。结果低分子肝素钙对急性脑梗死疗效明显，与对照组比较差异有显著性，未见不良反应。结论低分子肝素钙减轻急性脑梗死进展程度，有利于加快患者神经功能恢复。     

低分子肝素治疗急性脑梗死34例疗效观察

2001年8月至2003年2月，我院采用低分子肝素(LMWH)治疗34例脑梗死患者，疗效较好。现报告如下。     

低分子肝素钙治疗急性脑梗死的疗效观察

目的研究低分子肝素钙对急性脑梗死病人的治疗效果.方法脑梗死病人60例,随机分为治疗组和对照组,对照组应用葛根素注射液0.4加入5%葡萄糖250 mL静脉输注,每日1次,15 d为1个疗程,共用2个疗程.治疗组在上述基础上加低分子肝素钙0.6 mL皮下注射,每日2次,10 d为1个疗程,共用2个疗程.两组病人均于治疗前后进行神经功能缺损评分、判定疗效.结果经2个疗程治疗后对照组总有效率为83.3%,治疗组总有效率为96.7%,两组总有效率比较有统计学意义(P＜0.01).结果低分子肝素钙皮下注射加常规治疗可提高急性脑梗死的临床疗效.     

磺达肝癸钠和低分子肝素钙治疗急性非ST段抬高型心肌梗死的疗效对比

目的比较磺达肝癸钠和低分子肝素钙对急性非ST段抬高型心肌梗死（NSTEMI）的临床疗效及安全性。方法纳入2011年10月～2013年3月间急性NSTEMI患者120例,随机分为对照组（n=56）和治疗组（n=64）,所有患者均接受常规药物治疗,控制血压、血糖,对照组予低分子肝素钙0.1 ml/10 kg皮下注射（q12 h）,连用7 d;治疗组给予磺达肝癸钠2.5 mg/d皮下注射（qd）,连用7 d。于基线和首次给药2 h后检测血栓弹力图（thrombelastography,TEG）,同时观察治疗7 d及30 d后主要不良心血管事件（MACE,包括再发心绞痛、再发心肌梗死、死亡、恶性心律失常）发生率及出血率。结果对照组与治疗组基线血栓弹力图反应时间（TEG-R,5.25 min vs.4.98 min）和治疗2 h后的TEG-R（11.05 min vs.13.40 min）均无统计学差异（P＞0.05）。治疗过程中对照组和治疗组MACE发生率无统计学差异（7 d：21.43%vs.6.25%;30 d：21.43%vs.9.38%;P均＞0.05）。治疗7 d后,两组严重出血发生率无统计学差异（5.36%vs.1.56%）,但治疗组轻度出血发生率较对照组明显减少（3.13%vs.23.21%,P＜0.05）;治疗30 d后,治疗组严重出血（0 vs.7.14%）和轻度出血（4.69%vs.26.79%）发生率较对照组显著降低,两组差异有统计学意义（P＜0.05）。结论磺达肝癸钠与低分子肝素钙治疗NSTEMI同等有效且安全性更佳。     

不同时段再灌注治疗急性心肌梗死疗效的比较

目的:通过不同时段再灌注对急性ST段抬高型心肌梗死(ASTEMI)患者出院12个月随访,探讨不同时段再灌注方法对ASTEMI的终点事件、心功能预后的影响。方法:选择2006年1月~2008年1月,我科住院ASTEMI患者238例。根据是否接受冠状动脉介入治疗(PCI)及心肌再灌注时间分为3组:急诊PCI组(胸痛12 h)89例;晚期PCI组(胸痛24 h)86例;保守组(胸痛24 h)63例。分别记录3组的临床资料,出院后12个月进行电话随访,预约心动超声检查。结果:①3组出院12个月主要终点事件心源性死亡率有显著性差异(P0.05),次要终点事件心肌梗死、心力衰竭再入院率均有显著性差异(P0.05)。②出院12个月急诊PCI组较晚期PCI组心功能的左室射血分数(LVEF)显著增加、左室舒张末内径(LVEDD)显著缩小,急诊PCI组vs.保守治疗组LVEF、LVEDD均有显著性差异(P0.05)。结论:在降低终点事件,提高心功能方面,急诊PCI预后优于晚期PCI,晚期PCI优于保守治疗。     

Subcutaneous low-molecular-weight heparin for treatment of Trousseau's syndrome

 We report the case of a 76-year-old man with recurrent thromboses despite oral anticoagulation with phenprocoumon and low-grade chronic disseminated intravascular coagulation. Workup revealed a bronchial carcinoma (NSCCL) with hilar and mediastinal lymph node metastases. The clinical condition was consistent with Trousseau's syndrome. Based on reports in the literature, the therapy was changed to intravenous unfractionated heparin (UFH), which was effective in controlling the thrombotic coagulopathy. For practical reasons, despite a lack of evidence of its effectiveness in Trousseau's syndrome, therapy with UFH was changed to subcutaneous low-molecular-weight heparin (LMWH, nadroparine) in therapeutic doses of 100 IU/kg body wt. 12 hourly. On an outpatient basis, five chemotherapy cycles were administered, and after metastases of the brain had been detected radiotherapy was initiated. Following 7.5 months of progressive neoplastic disease the patient died. He had remained free of thromboembolic complications under continued LMWH therapy during the last 6.5 months of his life. LMWH might be a convenient alternative to the established therapy with UFH in Trousseau's syndrome. Received: 20 June 1997 / Accepted: 23 July 1997     

Long-term treatment of venous thromboembolism with low-molecular-weight heparin

Vitamin K antagonists are the most widely used form of long-term treatment of patients with venous thromboembolism (VTE). In certain patients, however, the desire to initiate oral anticoagulant therapy is tempered by concern about the risk of bleeding. In these cases, consideration should be given to alternative forms of treatment. Unfractionated heparin (UFH) may be an alternative, but it requires twice-daily subcutaneous administration, and the dosage must be adjusted after periodic blood tests. Therapy with low-molecular-weight heparin (LMWH) is the likely practical solution to this dilemma. Up to now, four small randomized trials have compared the efficacy and safety of LMWH therapy as an alternative to oral anticoagulants. When the results of the four studies are combined, a significant decrease is found in the bleeding rate in patients receiving LMWH. Two further studies by our group confirm this lower bleeding rate in patients on LMWH therapy. According to these data, we suggest that LMWH could be an alternative to oral anticoagulants in patients who cannot attend the laboratory for prothrombin time monitoring, as well as those who are at high risk for bleeding.     

不同时期无创肢体缺血预适应对急性心肌梗死大鼠的保护作用

目的:探讨急性心肌梗死前、再灌注前及再灌注时等不同时期,无创性肢体缺血预适应在减轻大鼠缺血/再灌注损伤中的作用。方法:所有大鼠随机分为4组(每组10只):心肌缺血/再灌注损伤组(A组)、急性心肌梗死前肢体缺血预适应组(B组)、再灌注前肢体缺血预适应组(C组)和再灌注初期肢体缺血预适应组(D组)。观察各组心电、心肌缺血范围(AAR)、心肌梗死范围(IA)、心肌梗死部位质量与左心室质量(LV)的比值(IA/LV)、梗死范围与缺血范围的比值(IA/AAR)、CK-MB值。结果:与A组相比,B、C、D 3组ST段抬高幅度、CK-MB值、IA/LV和IA/AAR比值均显著降低(P<0.01)。结论:无创性肢体缺血预适应在急性心肌梗死前、再灌注前及再灌注时的各个时期应用,都能明显降低大鼠心肌缺血/再灌注时的ST段抬高幅度,明显降低心肌酶水平,明显缩小心肌坏死面积。     

不同时间窗延迟经皮冠状动脉介入治疗对急性ST段抬高型心肌梗死患者预后的影响

目的 探讨不同时间窗延迟经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）对急性ST段抬高型心肌梗死（ST-elevation myocardial infarction,STEMI）患者预后的影响.方法 将2010年1月至2013年1月因STEMI入住广东药学院第一附属医院的109例患者分为两组：A组55例（PCI治疗时间窗为12～24 h）,B组54例（PCI治疗时间窗为5～14 d）.A组行延迟PCI治疗后予积极药物治疗,B组经积极药物治疗患者病情稳定后行延迟PCI治疗.于入院3d内、1个月、1年分别行超声心动图检查,计算左心室收缩末容积指数（LVESVI）、左心室舒张末容积指数（LVEDVI）和左心室射血分数（LVEF）,并判断左心功能的状况以及观察患者发病后1年内主要心血管事件（MACE）的发生情况.结果 两组患者术前基本临床情况以及术中情况比较,差异无统计学意义（P＞0.05）.两组在入院3d内左心功能比较,差异无统计学意义（P＞0.05）;术后1个月、1年两组患者左心功能均有改善,A组左心功能改善程度明显比B组好,差异有统计学意义（P＜0.05）.A组在复合心血管事件、心力衰竭以及心源性病死率等方面较B组明显下降,差异有统计学意义（P＜0.05）.结论 错过最佳再灌注时机的急性STEMI患者在发病24 h内行延迟PCI治疗仍可使患者更多获益.     

Optimizing adjunctive antithrombotic therapy in the treatment of acute myocardial infarction: a role for low-molecular-weight heparin

Thrombotic complications account for a large proportion of in-hospital deaths from acute myocardial infarction (MI). Although thrombolytic therapy has greatly improved clinical outcomes following MI, thrombin released during clot lysis has a prothrombotic effect, and the thrombolytic agents themselves may directly activate platelets. Antithrombotic therapy as an adjunct to thrombolysis improves the speed and extent of artery recanalization and reduces the incidence of secondary ischemic complications. The current treatment standard is unfractionated heparin (UFH) administered intravenously for 24-48 h. However, UFH has not been unequivocally shown to improve outcomes in large-scale, randomized clinical trials, and shows no evidence of benefit when used as an adjunct to streptokinase-based thrombolysis. Unfractionated heparin also has several clinical and practical disadvantages, such as the need for coagulation monitoring, difficulties attaining a stable and reliable anticoagulant effect, and the risk of hemorrhagic side effects. Low-molecular-weight heparin (LMWH) represents a safe and effective alternative antithrombotic therapy, with a stable and predictable anticoagulant effect, potential for use in combination with either fibrin-specific or streptokinase-based thrombolysis, no need for anticoagulation monitoring, and a low risk of hemorrhagic and other heparin-related complications. Several randomized clinical trials have shown that adjunctive LMWH is at least as effective as UFH in the acute phase of MI, is associated with fewer in-hospital recurrent ischemic events, and has an acceptable safety profile.     

Uses of low-molecular-weight heparin

Low-molecular-weight-heparin fractions are prepared from standard unfractionated heparin and are thus similar to unfractionated heparin in many aspects. The main advantages of this new class of antithrombotic agents as compared with unfractionated heparin are: (1) an improved bioavailability and a prolonged half-life, which alleviate cumbersome laboratory monitoring and may permit one single daily subcutaneous injection; (2) an improved efficacy-to-safety ratio, with less bleeding despite similar or improved efficacy. While low-molecular-weight heparin should replace unfractionated heparin for preventing postoperative thromboembolism, some unresolved issues remain to be addressed in specific trials before low-molecular-weight heparin can generally replace unfractionated heparin for all indications. These issues include the use of low-molecular-weight heparin in patients with arterial thrombosis, unstable angina, or myocardial infarction (usually in conjunction with thrombolytic treatment), and in patients with symptomatic pulmonary embolism, as well as formal cost-effectiveness analyses substantiating the advantages of the new agents. The potential of using low-molecular-weight-heparin outpatient treatment of established deep-vein thrombosis should be scrutinized from an economic and logistic point of view because two large-scale controlled trials have suggested both efficacy and safety.