急性脑梗死动脉溶栓与机械取栓后24h 内应用低分子肝素抗凝治疗的临床研究

目的：评价急性脑梗死动脉溶栓联合机械取栓24 h 内应用低分子肝素抗凝治疗的疗效与安全性。方法临床收集72例急性脑梗死患者并随机分为两组，治疗组与对照组各36例，均在患者发病后6 h 内行尿激酶选择性动脉溶栓及机械取栓治疗，术后即刻复查颅脑 CT。对照组仅给常规治疗，治疗组在常规治疗基础上，术后2 h 给予低分子肝素治疗。比较两组术前、术后24 h、21d 神经功能缺损评分、治疗21 d 后疗效及 BI 评分、治疗3月后血管再闭塞率。结果治疗后2组 NIHSS 评分均随着时间逐渐下降，治疗7 d、14 d、21 d 后，治疗组 NIHSS 评分比对照组下降显著，差异均有统计学意义。2组治疗21 d 后与治疗前 NIHSS 评分比较均下降，差异具有统计学意义。治疗21d 后，治疗组疗效优于对照组，差异有统计学意义（显效率：83.33% vs50.00%；显效率：100.00% vs83.33%）。2组BI 评分比较，差异有统计学意义。治疗3月后，血管再闭塞率治疗组较对照组低，差异具有统计学意义（11.1%vs33.3%）。结论急性脑梗死患者动脉溶栓与机械取栓后24h 内应用肝素抗凝治疗，神经功能改善、溶栓效果较好，残疾、血管再闭塞发生率低，且不增加出血风险。

Clinical research of the effect of low molecule weight heparin anticoagulation within 24h on acute cerebral infarction patients treatedwith arterial thrombolysis and mechanical thrombectomy

Objective：This study aimed to evaluate the efficacy and safety of low molecule weight heparin anticoagulation within 24h on acute cerebral infarction patients treated with arterial thrombolysis and mechanical thrombectomy. Methods：24 patients diagnosed with acute cerebral infarction were randomly bisected into therapy group and control group. Both groups were treated with selective intra - arterial thrombolysis with urokinase and mechanical thrombectomy in 6h,brain CT review was given immediately after the operation. Patients in control group were administrated with regular treatments,while therapy group was additionally administrated low molecule weight heparin 2h after the operation. Preoperative and postoperative 24h, 21d scores of NIHSS and postoperative 21d scores of BI,curative effects and postoperative 3 months vascular occlusion rate were compared between the two groups. Results：The NIHSS scores of both groups were gradually decreased,treatment group decreased significantly compared to the control group,the differences were statistically significant . After 21d’treatment,the NIHSS scores of both groups decreased,with statistical differences . Therapy group performed better curative effects than control group,with statistical differences between two groups（Incidences of significant efficiency：83. 33% vs50. 00% ,Inci-dences of efficiency：100. 00% vs83. 33% ）. After 3 months’treatment,the treatment group performed lower vascular occlu-sion rate than the control group（8. 3% vs25% ）. Conclusion：Low molecule weight heparin anticoagulation within 24h has a significant curative effect on acute cerebral infarction patients treated with arterial thrombolysis and mechanical thrombecto-my. It can improve neurological recovery and reduce the incidence of disability vascular reocclusion without increasing the risk of bleeding.