纖溶酶治療進(jìn)展性缺血性腦卒中合并糖尿病患者的臨床觀察
發(fā)布時(shí)間：2018-08-09 09:05
【摘要】：目的： 觀察進(jìn)展性缺血性腦卒中合并糖尿病患者及不合并糖尿病患者在治療過(guò)程中的凝血酶原時(shí)間、活化部分凝血活酶時(shí)間、纖維蛋白原、神經(jīng)功能缺損評(píng)分等的變化，探討加用纖溶酶注射液治療后上述指標(biāo)的變化，推測(cè)纖溶酶注射液發(fā)揮阻止血栓進(jìn)展的可能機(jī)制。 方法： 將60例進(jìn)展性缺血性腦卒中合并糖尿病的患者分為常規(guī)治療組30例及纖溶酶給藥組30例，另選進(jìn)展性缺血性腦卒中不合并糖尿病患者28例也給予常規(guī)治療作為對(duì)照組。常規(guī)治療組給予基礎(chǔ)的改善循環(huán)、營(yíng)養(yǎng)神經(jīng)及對(duì)癥支持治療。纖溶酶給藥組在此基礎(chǔ)上加用纖溶酶注射液（確診24小時(shí)內(nèi)給藥，用藥時(shí)間為10天）。三組分別于給藥24小時(shí)后、4天后、7天后、10天后測(cè)定凝血常規(guī)及行神經(jīng)功能缺損評(píng)分。 結(jié)果： 各組進(jìn)展性缺血性腦卒中患者在用藥治療24小時(shí)后、4天后、7天后、10天后PT、APTT均有上升趨勢(shì)，但合并糖尿病并聯(lián)合纖溶酶治療組患者PT、APTT水平上升較顯著（P0.05）。 常規(guī)治療組及對(duì)照組均于用藥第4天時(shí)發(fā)現(xiàn)FBG水平顯著上升，隨后測(cè)得值較第4天時(shí)有所下降，但未下降至24小時(shí)水平（P0.05）；纖溶酶給藥組除用藥第4天時(shí)的其余各時(shí)間點(diǎn)FBG水平均顯著下降（P0.01）。 常規(guī)治療組與對(duì)照組NIHSS評(píng)分提示用藥第4天時(shí)NIHSS評(píng)分較24小時(shí)后升高較顯著（P0.05）；于用藥7天后、10天后測(cè)得NIHSS評(píng)分均下降，但下降水平較用藥第4天后水平無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；同時(shí)纖溶酶用藥組用藥第4天與24小時(shí)相比NIHSS評(píng)分有所升高，但升高不明顯，相比較無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；7天及10天后NIHSS評(píng)分較4天后測(cè)得水平顯著下降（P0.01）。 上述變化提示可能與用藥4天左右的時(shí)間點(diǎn)上病情恰好進(jìn)展至高峰有關(guān)，而纖溶酶在病情進(jìn)展至高峰的過(guò)程中能有效控制纖維蛋白原水平。 常規(guī)治療組與對(duì)照組相比較，即合并糖尿病與不合并糖尿病的進(jìn)展性缺血性腦卒中的患者在相同的治療條件、治療方法情況下，用藥4天內(nèi)神經(jīng)功能缺損評(píng)分上升程度無(wú)明顯差異，用藥4天后神經(jīng)功能缺損評(píng)分下降的程度亦無(wú)顯著差異（P0.05）。而應(yīng)用纖溶酶治療組，用藥4天內(nèi)神經(jīng)功能缺損評(píng)分上升程度不明顯，但用藥4天后下降程度顯著（P0.01）。提示，，無(wú)論是否合并糖尿病，應(yīng)用纖溶酶治療后神經(jīng)功能缺損程度與常規(guī)治療手段相比降低程度更顯著（P0.01）。 另外，進(jìn)展性缺血性腦卒中患者用藥治療4天后病情進(jìn)展的情況比較，纖溶酶給藥組較常規(guī)治療組及對(duì)照組用藥治療后起到阻止病情進(jìn)展的作用顯著提高（P0.05）。 結(jié)論： 1.纖維蛋白原增高是血栓形成、病情進(jìn)展的主要危險(xiǎn)因素，與合并糖尿病的進(jìn)展性缺血性腦卒中患者的病情進(jìn)展更是密切相關(guān)。 2.纖溶酶可通過(guò)降低纖維蛋白原水平，降低血液黏度及血管進(jìn)一步狹窄的發(fā)生率進(jìn)而起到抗栓作用，最終控制進(jìn)展性缺血性腦卒中患者的病情進(jìn)展并能及早治療疾病、改善預(yù)后。 3.纖溶酶對(duì)于進(jìn)展性缺血性腦卒中合并糖尿病的患者有良好的治療效果，可有效改善微循環(huán)障礙，阻止病情進(jìn)展，顯著降低神經(jīng)功能缺損評(píng)分，且用藥安全，無(wú)出血風(fēng)險(xiǎn)，目前尚未發(fā)現(xiàn)其所致的出血病例，適合推廣使用。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743.3;R587.1
本文編號(hào)：2173601
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743.3;R587.1
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