纤溶酶治疗进展性缺血性脑卒中合并糖尿病患者的临床观察

发布时间：2018-08-09 09:05

【摘要】：目的：观察进展性缺血性脑卒中合并糖尿病患者及不合并糖尿病患者在治疗过程中的凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、神经功能缺损评分等的变化，探讨加用纤溶酶注射液治疗后上述指标的变化，推测纤溶酶注射液发挥阻止血栓进展的可能机制。方法：将60例进展性缺血性脑卒中合并糖尿病的患者分为常规治疗组30例及纤溶酶给药组30例，另选进展性缺血性脑卒中不合并糖尿病患者28例也给予常规治疗作为对照组。常规治疗组给予基础的改善循环、营养神经及对症支持治疗。纤溶酶给药组在此基础上加用纤溶酶注射液（确诊24小时内给药，用药时间为10天）。三组分别于给药24小时后、4天后、7天后、10天后测定凝血常规及行神经功能缺损评分。结果：各组进展性缺血性脑卒中患者在用药治疗24小时后、4天后、7天后、10天后PT、APTT均有上升趋势，但合并糖尿病并联合纤溶酶治疗组患者PT、APTT水平上升较显著（P0.05）。常规治疗组及对照组均于用药第4天时发现FBG水平显著上升，随后测得值较第4天时有所下降，但未下降至24小时水平（P0.05）；纤溶酶给药组除用药第4天时的其余各时间点FBG水平均显著下降（P0.01）。常规治疗组与对照组NIHSS评分提示用药第4天时NIHSS评分较24小时后升高较显著（P0.05）；于用药7天后、10天后测得NIHSS评分均下降，但下降水平较用药第4天后水平无统计学意义（P0.05）；同时纤溶酶用药组用药第4天与24小时相比NIHSS评分有所升高，但升高不明显，相比较无统计学意义（P0.05）；7天及10天后NIHSS评分较4天后测得水平显著下降（P0.01）。上述变化提示可能与用药4天左右的时间点上病情恰好进展至高峰有关，而纤溶酶在病情进展至高峰的过程中能有效控制纤维蛋白原水平。常规治疗组与对照组相比较，即合并糖尿病与不合并糖尿病的进展性缺血性脑卒中的患者在相同的治疗条件、治疗方法情况下，用药4天内神经功能缺损评分上升程度无明显差异，用药4天后神经功能缺损评分下降的程度亦无显著差异（P0.05）。而应用纤溶酶治疗组，用药4天内神经功能缺损评分上升程度不明显，但用药4天后下降程度显著（P0.01）。提示，，无论是否合并糖尿病，应用纤溶酶治疗后神经功能缺损程度与常规治疗手段相比降低程度更显著（P0.01）。另外，进展性缺血性脑卒中患者用药治疗4天后病情进展的情况比较，纤溶酶给药组较常规治疗组及对照组用药治疗后起到阻止病情进展的作用显著提高（P0.05）。结论： 1.纤维蛋白原增高是血栓形成、病情进展的主要危险因素，与合并糖尿病的进展性缺血性脑卒中患者的病情进展更是密切相关。 2.纤溶酶可通过降低纤维蛋白原水平，降低血液黏度及血管进一步狭窄的发生率进而起到抗栓作用，最终控制进展性缺血性脑卒中患者的病情进展并能及早治疗疾病、改善预后。 3.纤溶酶对于进展性缺血性脑卒中合并糖尿病的患者有良好的治疗效果，可有效改善微循环障碍，阻止病情进展，显著降低神经功能缺损评分，且用药安全，无出血风险，目前尚未发现其所致的出血病例，适合推广使用。
[Abstract]:Objective:
To observe the changes of prothrombin time, activated partial thromboplastin time, fibrinogen and neurological deficit score during the treatment of progressive ischemic stroke with diabetes and non diabetic patients in the treatment process, and to explore the changes of the above indexes after the addition of Fibrinogenase Injection, and to speculate that Fibrinogenase Injection exerts a hindrance. The possible mechanism for the progression of hemostasis.
Method:
60 patients with progressive ischemic stroke and diabetes were divided into routine treatment group (30 cases) and fibrinolytic enzyme group (30 cases). Another 28 patients with progressive ischemic stroke and non diabetic patients were given conventional treatment as control group. The routine treatment group was given basic improvement cycle, nutritional nerve and symptomatic support therapy. On this basis, the drug group was added with Fibrinogenase Injection (the medicine was given within 24 hours and the time of medication was 10 days). The three groups were treated for 24 hours after 24 hours, 4 days after 7 days, and 10 days after 10 days, and the scores of nerve function defect were measured.
Result:
In each group of progressive ischemic stroke patients after 24 hours of medication, 4 days later, 7 days after 7 days, and 10 days later, PT, APTT had an upward trend, but the level of APTT in the patients with diabetes combined with fibrinolytic enzyme group increased significantly (P0.05).
In both the conventional treatment group and the control group, the FBG level was significantly increased at fourth days, and then the measured value decreased to some fourth days, but did not decrease to 24 hours (P0.05), and the FBG level of the fibrinolytic enzyme group decreased significantly at the rest of the fourth days (P0.01).
The NIHSS score of the conventional treatment group and the control group suggested that the NIHSS score increased significantly after fourth days (P0.05), and the NIHSS score decreased in 10 days after 7 days of medication, but the decrease level was not statistically significant compared with the fourth days after the medication (P0.05). At the same time, the NIHSS score of the fibrinolytic enzyme group was compared with the 24 hours of the NIHSS score. The NIHSS score was significantly lower after 7 days and 10 days than that after 4 days (P 0.01).
These changes may be associated with the onset of the disease at a time of 4 days or so, and the fibrinogen can be effectively controlled during the progression of the disease to the peak.
Compared with the control group, there was no significant difference in the increase of nerve function defect score within 4 days, and there was no significant difference in the degree of neurological deficit score decreased after 4 days of medication (P 0.05). But with the use of fibrinolytic enzyme group, the increase of nerve function defect score in 4 days was not obvious, but the degree of decline was significant (P0.01) after 4 days. It was suggested that the degree of nerve function defect after treatment with fibrinolytic enzyme was more significant than that of conventional therapy (P0.01).
In addition, compared with the progress of the patients with progressive ischemic stroke after 4 days of treatment, the effect of the fibrinolytic enzyme group was significantly higher than that of the conventional treatment group and the control group after the treatment of the treatment group and the control group to prevent the progression of the disease (P0.05).
Conclusion:
The increase of 1. fibrinogen is a major risk factor for thrombosis and is closely related to the progression of patients with progressive ischemic stroke with diabetes.
2. fibrinolytic enzyme can reduce the level of fibrinogen, reduce the incidence of blood viscosity and further vascular stenosis, and then play an antithrombotic effect. Finally, it can control the progression of patients with progressive ischemic stroke and can treat the disease early and improve the prognosis.
3. fibrinolytic enzyme has good therapeutic effect on patients with progressive ischemic stroke and diabetes. It can effectively improve the microcirculation disorder, prevent the progression of the disease, significantly reduce the score of nerve function defect, and the drug is safe and no bleeding risk. At present, no bleeding cases have been found. It is suitable for popularization and use.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3;R587.1

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