肝素钠持续泵入治疗急性脑梗死的疗效及超敏C反应蛋白的变化

目的探讨肝素钠持续微量泵入抗凝治疗急性脑梗死的疗效及与hs-CRP动态变化的关系。方法采用随机对照的前瞻性研究方法,选择发病48h内入院的脑梗死患者126例,随机分为治疗组和对照组。治疗组62例采用肝素钠首剂20~30mg生理盐水稀释10mL静注后每8h50mg加生理盐水50mL静脉泵入,根据每8h复查APTT的变化调整剂量,逐渐减量持续72~96h;对照组给予常规治疗,观察比较2组治疗3d和10d神经功能缺损程度NIHSS评分和hs-CRP;随访30d,比较2组日常生活质量Barthel指数,记录不良事件。结果治疗组总有效率(83.8%)明显高于对照组(65.6%),差异有统计学意义(P0.05);治疗组hs-CRP与降低幅度明显高于对照组(P0.01),Barthel指数明显优于对照组(P0.05)。结论肝素钠持续微量静脉泵入可显著减轻急性脑梗死患者的神经功能缺损程度,并与肝素钠抗炎作用相关,增加治愈率,提高患者的远期生活质量,出血风险并未增高。

The curative effect of continuously pumping of heparin on acute cerebral stroke and its relationship with hyper-sensitive C-reactive protein

Objective To explore curative effect of continuously pumping of heparin on acute cerebral stroke and its rela-tionship with hypersensitive C-reactive protein.Methods We used randomized prospective method in our study.After selecting 126 patients with acute cerebral stroke within 48 hours of onset,we divided them into study group and control group.Sixty-two pa-tients in the study group firstly received intravenous heparin with initial dose of 20 to 30 mg which was diluted by 10 mL of normal saline and then received continuously intravenous pumping of 50 mg of heparin diluted by 50 mL of normal saline every eight hours.The dosage was adjusted based on the change of APTT value which was reexamined every eight hours and was gradually re-duced in order to last for 72 to 96 hours.And the control group received routine therapy.Three and ten days later we observed neu-rological function deficit scores and the level of hs-CRP,and thirty days after following up we recorded Barthel index and adverse events.Results Total effective rate in treatment group(83.8%)was obviously higher than 65.6% in control group,and the difference had statistical significance(P<0.05).The treatment group showed higher hs-CRP level and more changes than the con-trol group(P<0.05).After thirty days,the treatment group made better progress in Barthel index(P<0.01).Conclusion Con-tinuously pumping of heparin which may be related with anti-inflammatory action,can effectively relieve neurological function defi-cits,increase improvement rate and improve long-term quality of life without an increase in bleeding risk in acute cerebral stroke patients.