尿激酶联合奥扎格雷钠治疗高龄急性脑梗死患者临床观察
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摘要
目的探讨尿激酶联合奥扎格雷钠治疗80岁以上高龄急性脑梗死患者的临床疗效及安全性。方法选取2014年1月至2017年12月我院收治的80岁以上高龄急性脑梗死患者66例为研究对象,根据患者及家属意愿将纳入研究的老年患者分为溶栓治疗组(36例)和非溶栓治疗组(30例),采用随机数字表法将溶栓治疗组患者随机分为联合溶栓组(18例)和尿激酶溶栓组(18例)。联合溶栓组患者采用尿激酶联合奥扎格雷钠治疗,尿激酶溶栓组患者采用尿激酶治疗,非溶栓治疗组患者采用奥扎格雷钠治疗。比较三组患者治疗24 h、3 d、7 d后的卒中量表(NIHSS)评分;比较三组患者治疗7 d的出血事件发生率和病死率。结果治疗方法与治疗时间对三组患者NIHSS评分的影响存在差异(P <0. 05);治疗方法与治疗时间之间无交互作用(P> 0. 05)。治疗7 d后,三组患者的治疗有效率、显效率比较差异有统计学意义,表现为联合溶栓组>尿激酶溶栓组>非溶栓治疗组;联合溶栓组患者的显效率显著高于非溶栓治疗组,差异有统计学意义(P <0. 05)。治疗7 d,三组患者的出血事件发生率及病死率比较,差异无统计学意义(P> 0. 05)。结论尿激酶联合奥扎格雷钠治疗80岁以上高龄急性脑梗死患者早期临床疗效显著,不会增加患者出血及死亡风险。
Objective To investigate the clinical efficacy and safety of urokinase combined with sodium ozagrel in the treatment of elderly patients with acute cerebral infarction over 80 years old. Methods 66 patients with acute cerebral infarction over 80 years old admitted in our hospital from January 2014 to December 2017 were selected as subjects. All subjects enrolled in the study were divided into thrombolytic therapy group( 36 cases) and non-thrombolytic therapy group( 30 cases) according to voluntary principle. Patients in the thrombolytic group were divided into combined thrombolytic group( 18 cases) and urokinase thrombolytic group( 18 cases) according to random number table method. Combined thrombolysis group were given urokinase combined with sodium ozagrel,urokinase thrombolytic group were treated with urokinase,and non-thrombolytic group were treated with sodium ozagrel. The National Institutes of Health Stroke Scale( NIHSS) score of the three groups were compared after 24 h,3 d,7 d of treatment. The incidence of hemorrhagic events and mortality in the three groups were compared. Results The effects of therapy and therapeutic time on NIHSS score in the three groups were significantly difference( P < 0. 05). There was no interaction between therapy and therapeutic time( P > 0. 05). After 7 d of treatment,the difference of effective rate and markedly effective rate in the three groups were statistically significant,the combined thrombolytic group > urokinase thrombolytic group > non-thrombolytic group.The markedly effective rate of combined thrombolytic group was significantly higher than non-thrombolytic group,the difference was statistically significant( P < 0. 05). There was no significant difference in the incidence of hemorrhagic events and mortality between the three groups( P > 0. 05). Conclusion The clinical efficacy of urokinase combined with sodium ozagrel in the treatment of patients with acute cerebral infarction over 80 years old is effective and safety,and it will not increase the risk of cerebral hemorrhage and death.
Objective To investigate the clinical efficacy and safety of urokinase combined with sodium ozagrel in the treatment of elderly patients with acute cerebral infarction over 80 years old. Methods 66 patients with acute cerebral infarction over 80 years old admitted in our hospital from January 2014 to December 2017 were selected as subjects. All subjects enrolled in the study were divided into thrombolytic therapy group( 36 cases) and non-thrombolytic therapy group( 30 cases) according to voluntary principle. Patients in the thrombolytic group were divided into combined thrombolytic group( 18 cases) and urokinase thrombolytic group( 18 cases) according to random number table method. Combined thrombolysis group were given urokinase combined with sodium ozagrel,urokinase thrombolytic group were treated with urokinase,and non-thrombolytic group were treated with sodium ozagrel. The National Institutes of Health Stroke Scale( NIHSS) score of the three groups were compared after 24 h,3 d,7 d of treatment. The incidence of hemorrhagic events and mortality in the three groups were compared. Results The effects of therapy and therapeutic time on NIHSS score in the three groups were significantly difference( P < 0. 05). There was no interaction between therapy and therapeutic time( P > 0. 05). After 7 d of treatment,the difference of effective rate and markedly effective rate in the three groups were statistically significant,the combined thrombolytic group > urokinase thrombolytic group > non-thrombolytic group.The markedly effective rate of combined thrombolytic group was significantly higher than non-thrombolytic group,the difference was statistically significant( P < 0. 05). There was no significant difference in the incidence of hemorrhagic events and mortality between the three groups( P > 0. 05). Conclusion The clinical efficacy of urokinase combined with sodium ozagrel in the treatment of patients with acute cerebral infarction over 80 years old is effective and safety,and it will not increase the risk of cerebral hemorrhage and death.
引文
[1]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[2]李艳琴.动静脉联合溶栓对急性脑梗死患者预后的影响[J].中国实用神经疾病杂志,2016,19(20):29-30.
[3]韦冲.尿激酶溶栓加丹奥后续抗栓治疗急性脑梗死10例分析[J].华夏医学,2005,18(1):41-42.
[4] Yoo AJ,Barak ER,Copen WA,et al. Combining acute diffusion-weighted imaging and mean transmit time lesion volumes with national institutes of health stroke scale score improves the prediction of acute stroke outcome[J]. Stroke,2010,41(8):1728-1735.
[5] NINDS rt-PA Stroke Study Group N. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group[J]. New England J Med,1995,333(24):1581-1587.
[6] Joo H,Liang D. Economic burden of informal care attributable to stroke among those aged 65 years or older in China[J]. Int J Stroke,2017,12(2):205-207.
[7]赵志斌. 80岁以上急性脑梗死尿激酶溶栓分析[J].中国实用医药,2015,10(6):171-173.
[8]余练,严洪新,罗建华.超高龄脑梗死患者超早期应用尿激酶静脉溶栓的效果及安全性[J].血栓与止血学,2017,23(6):915-917.
[9]齐献忠,李力.小剂量尿激酶联合奥扎格雷钠治疗进展性脑梗死疗效分析[J].中国实用神经疾病杂志,2011,14(4):41-42.
[10]胡文杰.奥扎格雷钠联合小剂量尿激酶治疗急性脑梗死的疗效及安全分析[J].中国医学工程,2012,20(6):144-145.
[11]郑树旺.小剂量尿激酶与奥扎格雷钠联合治疗进展性脑梗死的有效性及安全性分析[J].海峡药学,2015,43(7):28-29.
[12]陈晓燕,程赛宇,郭宇.阿替普酶联合肝素治疗高龄急性脑梗死患者的疗效观察[J].疑难病杂志,2012,11(9):658-660.
[13]农媛,肖海,陈奎,等.高龄急性脑梗死患者尿激酶联合奥扎格雷钠静脉溶栓治疗分析[J].吉林医学,2017,38(4):672-675.
[14]国家“九五”攻关课题协作组.急性脑梗死六小时以内的静脉溶栓治疗[J].中华神经科杂志,2002,35(4):210-213.
[2]李艳琴.动静脉联合溶栓对急性脑梗死患者预后的影响[J].中国实用神经疾病杂志,2016,19(20):29-30.
[3]韦冲.尿激酶溶栓加丹奥后续抗栓治疗急性脑梗死10例分析[J].华夏医学,2005,18(1):41-42.
[4] Yoo AJ,Barak ER,Copen WA,et al. Combining acute diffusion-weighted imaging and mean transmit time lesion volumes with national institutes of health stroke scale score improves the prediction of acute stroke outcome[J]. Stroke,2010,41(8):1728-1735.
[5] NINDS rt-PA Stroke Study Group N. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group[J]. New England J Med,1995,333(24):1581-1587.
[6] Joo H,Liang D. Economic burden of informal care attributable to stroke among those aged 65 years or older in China[J]. Int J Stroke,2017,12(2):205-207.
[7]赵志斌. 80岁以上急性脑梗死尿激酶溶栓分析[J].中国实用医药,2015,10(6):171-173.
[8]余练,严洪新,罗建华.超高龄脑梗死患者超早期应用尿激酶静脉溶栓的效果及安全性[J].血栓与止血学,2017,23(6):915-917.
[9]齐献忠,李力.小剂量尿激酶联合奥扎格雷钠治疗进展性脑梗死疗效分析[J].中国实用神经疾病杂志,2011,14(4):41-42.
[10]胡文杰.奥扎格雷钠联合小剂量尿激酶治疗急性脑梗死的疗效及安全分析[J].中国医学工程,2012,20(6):144-145.
[11]郑树旺.小剂量尿激酶与奥扎格雷钠联合治疗进展性脑梗死的有效性及安全性分析[J].海峡药学,2015,43(7):28-29.
[12]陈晓燕,程赛宇,郭宇.阿替普酶联合肝素治疗高龄急性脑梗死患者的疗效观察[J].疑难病杂志,2012,11(9):658-660.
[13]农媛,肖海,陈奎,等.高龄急性脑梗死患者尿激酶联合奥扎格雷钠静脉溶栓治疗分析[J].吉林医学,2017,38(4):672-675.
[14]国家“九五”攻关课题协作组.急性脑梗死六小时以内的静脉溶栓治疗[J].中华神经科杂志,2002,35(4):210-213.