脑梗死超早期尿激酶溶栓治疗疗效观察及临床意义

目的 观察脑梗死超早期尿激酶溶栓治疗效果并探讨其临床意义. 方法选取2011年6月～2013年2月新昌人民医院收治的急性脑梗死（ACI）患者62例, 根据治疗方法分为观察组与对照组各31例.观察组依患者体重差异选择（100～150）万U的尿激酶进行溶栓治疗,辅以尼莫地平保护脑神经、甘露醇清除过多氧自由基、低分子肝素钠及阿司匹林预防再闭塞;对照组除未用尿激酶外,其余皆与观察组相同. 结果观察组治疗后1d、2d、7d NIHSS评分均明显低于治疗前,对照组患者治疗后2d、7d NIHSS评分均明显低于治疗前,差异均具有统计学意义（P ＜ 0.05）.治疗前及治疗后2h观察组与对照组NIHSS评分比较,差异无统计学意义（P ＞ 0.05）;治疗后1d、2d、7d观察组NIHSS评分分别为（8.8±2.9）分、（7.4±3.1）分、（5.1±2.2）分,均明显低于对照组的（10.7±3.5）分、（10.3±2.8）分、（9.2±3.0）分,差异均具有统计学意义（P ＜ 0.05）;治疗后观察组总有效率为80.6%,对照组总有效率为67.7%,两组比较,差异具有统计学意义（P ＜ 0.05）. 结论只要严格掌握脑梗死超早期尿激酶静脉溶栓的适应证与禁忌证,无需特殊设备,就能为基层医院所用以紧急救治脑梗死患者.

Observation on the efficiency of urokinase thrombolytic therapy in ultra-early cerebral infarction and its clinical significance

Objective To observe the efficiency of urokinase thrombolytic therapy in ultra-early cerebral infarction and explore its clinical significance. Methods Sixty-two patients with acute cerebral infarction （ACI） received in Xinchang people＇s hospital from Jun., 2011 to Feb., 2013 were divided into observation group and control group according to a prospective randomized open method, 31 cases in each group. The patients in observation group were given thrombolytic therapy with 1~1.5 million U urokinase according to different body weights, and supplemented by nimodipine to protect the cranial？nerves, mannitol to remove excessive oxygen free radicals, low molecular weight heparin and aspirin to prevent re-occlusion. The treatment method in control group was the same as observation group except for urokinase. Results NIHSS scores ld, 2d and 7d after treatment in observation group as well as 2 d and 7d after treatment in control group were decreased obviously compared with treatment before, with significant differences（P 〈 0.05） Before and 2h after treatment, there was no statistical significance by comparison to the NIHSS scores in observation group and control group（P 〉 0.05）. ld, 2d and 7d after treatment, NIHSS scores in observation group （8.8＋2.9）, （7.4＋3.1） and （5.1＋2.2） points were significantly lower than those in control group （10.7＋3.5）, （10.3＋ 2.8） and （9.2 ~ 3.0） points, the differences were statistically significant（P 〈 0.05）. After treatment, the total effective rates in observation group and in control group were 80.6% and 67.7%, respectively, and the difference was statistically significant（P 〈 0.05）. Conclusion Only when indications and contraindications of urokinase thrombolytic therapy in ultra-early cerebral infarction are mastered strictly can the patients with cerebral infarction be given emergency aid and treatment in primary hospitals without special equipments.