阿替普酶溶栓后抗凝治疗对急性脑梗死患者的疗效及安全性研究(1)
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[摘要]目的 观察阿替普酶溶栓后抗凝治疗对急性脑梗死患者的疗效及安全性。方法 64例急性脑梗死患者根据是否使用抗凝治疗分为抗凝组和非抗凝组两组，每组各32例。全部入选对象均给予阿替普酶0.9mg/kg静脉注射，用药后即刻复查颅脑CT，排除脑出血。抗凝组32例给予肝素钠静脉泵入，调整剂量使APTT较基线值延长，3d后改为氯吡格雷或(和)阿司匹林口服；非抗凝组32例24h后予氯吡格雷或(和)阿司匹林口服。应用统计学方法分别比较两组的疗效，以及两组NIHSS评分治疗前后的变化情况。结果 两组基本痊愈率及总有效率比较，抗凝组的疗效优于非抗凝组(P<0.05)。两组NIHSS评分溶栓后7d以及溶栓后14d均较溶栓前明显降低(P<0.05)，且抗凝组溶栓后7d以及溶栓后14d的NIHSS评分较对照组降低更明显(P<0.05)。结论 在急性脑梗死发病后3～6h内静脉注射阿替普酶是安全和有效的，且溶栓后进行抗凝治疗有利于急性脑梗死患者急性期神经功能的恢复。
[关键词]急性脑梗死；阿替普酶；疗效；安全性
[中图分类号] R743.3 [文献标识码] B [文章编号] 1673-9701(2011)31-42-03
The Efficacy and Safety of Anticoagulant Therapy in Patients with Acute Cerebral Infarction after Alteplase Thrombolysis
ZHOU Peng
The Second People’s Hospital of Jiaxing City in Zhejiang Province， Jiaxing 314000，China
[Abstract] Objective To observe the efficacy and safety of alteplase in the treatment of acute cerebral infarction anticoagulant after thrombolysis. Methods All 64 patients with acute cerebral infarction were divided according anticoagulant therapy anticoagulant group and non-anticoagulant group 32 cases respect. All selected objects were given alteplase 0.9mg/kg static injection，medication review immediately after the brain CT，to exclude cerebral hemorrhage. Anticoagulant group of 32 patients was given intravenous heparin infusion，adjusting the dose so that extended from baseline APTT，3d later changed to clopidogrel or(and)oral aspirin； non-anticoagulant group of 32 patients was given clopidogrel after 24h or(and)aspirin orally. By application statistical methods and compared the efficacy of the two groups，and the two groups NIHSS score changes before and after treatment. Results Anticoagulant set of basic recovery rate was 25.0%，non-anticoagulant group of the basic recovery rate of 15.6%，anticoagulant total effective rate was 90.6%， the total effective rate of non-anticoagulant group was 71.9%. The basic recovery rate and total more efficient of the anticoagulant group was more effective than non-anticoagulant group， the difference was statistically significant(P<0.05). NIHSS score after thrombolysis 7 days of two group and 14 days after thrombolysis compared with thrombolytic therapy was significantly lower(P <0 ......
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