脑梗死尿激酶静脉溶栓后应用阿斯匹林联合低分子肝素防治再闭塞的疗效观察

目的:探讨尿激酶静脉溶栓后应用阿斯匹林联合低分子肝素防治再闭塞的疗效。方法:70例发病≤6h,头颅CT排除脑出血的急性脑梗死患者,随机分为2组,A组静脉注射尿激酶100～150万u,6h后应用阿斯匹林0.15g口服,每天1次,同时低分子肝素5000u皮下注射,每天2次,连用7天。B组静脉注射尿激酶100～150万u,24h后应用阿斯匹林0.15g口服,每天1次,连用7天。结果:2组共发生再闭塞8例,发生率11.4%。其中A组1例,占A组2.7%,B组7例,占B组21.2%,其差异有统计学意义(P<0.05)。再闭塞组的院内死亡率37.5%,非再闭塞组的院内死亡率4.8%,其差异有统计学意义(P<0.001)。再闭塞50%发生在溶栓后24h左右,37.5%发生在3d,12.5%发生在4～5d。2组发生脑出血率差异无统计学意义。2组14d有效率、显效率、痊愈率差异无统计学意义。结论:溶栓治疗后发生再闭塞率仍然较高,可能是急性脑梗死患者早期临床症状恶化的主要原因,再闭塞患者院内死亡率高,预后差。本试验显示溶栓治疗6h后应阿斯匹林加低分子肝素防治再闭塞的治疗是安全、有效的。

Therapeutic Effect of Aspirin and Low-molecular-weight Heparins Calcium in Preventing Reocclusion after Intravenous Thrombolysis with Urokinase

Objective：To evaluate the therapeutic effect of aspirin in combination with low-molecular-weight heparins calcium in preventing reocclusion after intravenous thrombolysis with urokinase.Methods：A total of 70 patients with acute cerebral infarction,who were treated within 6 hours after onset of cerebral infarction diagnosed with CT,were randomly divided into two groups（A and B）.The patients in group A received urokinase（1,000,000～1,500,000IU） by intravenous drip,then were given aspirin orally（150mg per day） and low-molecular-weight heparins calcium（5000u two times a day for 7 days） by injection subcutaneously after 6 hours,The patients in group B received urokinase（1,000,000～1,500,000IU） by intravenous drip,then took aspirin（150mg per day） orally after 24 hours.Results：8 patients（11.4%） in two groups suffered from reocclusion,of which 1 patient（2.7% of group A） belongs to group A,7 patients（21.2% of group B） group B.The difference between the two groups was significant statistically（P〈0.05）.Fatality rate was 37.5% in reocclusion group,4.8% in non-reocclusion group（P〈0.01）.The reocclusion of 50 percent of patients suffering from reocclusion took place in about 24 hours after intravenous thrombolysis,37.5 percent in about 3 days,12.5 percent in 4 to 5 days.The frequency of cerebral haemorrhage between group A and group B was not significant statistically.Conclusion：The reocclusion has a high rate of incidence after thrombolysis therapy,which might be the major cause of a deterioration in the patient＇ s early condition,with a high mortality rate and bad prognosis during hospitalization.It can be concluded that aspirin in combination with low-molecular-weight heparins calcium is safe and effective in preventing reocclusion after intravenous thrombolysis therapy.