【摘要】：目的 對(duì)小劑量尿激酶聯(lián)合常規(guī)治療老年短暫性腦缺血發(fā)作（TIA）的癥狀再發(fā)、凝血功能以及頸動(dòng)脈粥樣硬化斑塊的臨床影響進(jìn)行對(duì)比分析并探討其作用機(jī)制。 方法 把2012年8月~2013年10月期間在我院治療的滿足入組條件的53例老年短暫性腦缺血發(fā)作患者隨機(jī)分為A、B兩組，A組為尿激酶治療組，B組為常規(guī)治療組。A組27例（男性17例，女性10例，年齡80.11y±3.17y），應(yīng)用10萬U尿激酶聯(lián)合常規(guī)治療（即控制血壓、控制血糖、降脂穩(wěn)定斑塊、抗血小板聚集、改善腦循環(huán)等控制危險(xiǎn)因素治療）2周；B組26例（男性15例，女性11例，年齡79.96y±4.31y），應(yīng)用常規(guī)治療2周。對(duì)兩組治療前后的癥狀再發(fā)、凝血功能以及頸動(dòng)脈粥樣硬化斑塊平均面積進(jìn)行組間及組內(nèi)的對(duì)比分析，從而評(píng)估該治療方案的臨床療效及安全性。 結(jié)果 1、總有效率：A組顯效13例，有效8例，無效6例，惡化0例，總有效率77.8%；B組顯效7例，，有效5例，無效12例，惡化2例，總有效率46.2%，兩組總有效率對(duì)比有明顯差異，具統(tǒng)計(jì)學(xué)意義（P＜0.05）。 2、凝血功能變化：A組治療前后APTT、PT、INR數(shù)據(jù)對(duì)比，其變化無明顯差異，不具統(tǒng)計(jì)學(xué)意義（P＞0.05），B組治療前后APTT、PT、INR數(shù)據(jù)對(duì)比，其變化無明顯差異，不具統(tǒng)計(jì)學(xué)意義（P＞0.05）；A、B兩組治療后APTT、PT、INR數(shù)據(jù)對(duì)比，其變化無明顯差異，不具統(tǒng)計(jì)學(xué)意義（P＞0.05）；A組治療后其Fbg.、DD明顯下降，具統(tǒng)計(jì)學(xué)差異（P＜0.05），B組Fbg.、DD治療前后數(shù)據(jù)對(duì)比，變化無明顯差異，不具統(tǒng)計(jì)學(xué)意義（P＞0.05）；A、B兩組治療后對(duì)比，A組Fbg.、DD較B組有明顯下降，具統(tǒng)計(jì)學(xué)差異（P＜0.05）。 3、頸動(dòng)脈粥樣粥樣硬化斑塊平均面積變化：A組治療后頸動(dòng)脈粥樣硬化斑塊平均面積縮小有統(tǒng)計(jì)學(xué)意義（P＜0.05），B組治療前后頸動(dòng)脈粥樣硬化斑塊平均面積變化無明顯差異，不具統(tǒng)計(jì)學(xué)意義（P＞0.05）。A、B兩組治療后對(duì)比，A組頸動(dòng)脈粥樣硬化斑塊平均面積較B組縮小，具統(tǒng)計(jì)學(xué)差異（P＜0.05）。 4、安全性：兩組均無中樞神經(jīng)系統(tǒng)或其他部位出血情況發(fā)生。 結(jié)論 小劑量尿激酶聯(lián)合常規(guī)治療老年短暫性腦缺血發(fā)作臨床療效優(yōu)于常規(guī)治療；且該治療方案未見增加老年患者的出血風(fēng)險(xiǎn)，對(duì)于老年患者安全性高。
[Abstract]:Objective to compare and analyze the clinical effects of low-dose urokinase combined with routine therapy on the recurrence of symptoms, coagulation function and carotid atherosclerotic plaque in elderly patients with transient ischemic attack (TIA). Methods from August 2012 to October 2013, 53 elderly patients with transient ischemic attack were randomly divided into two groups: group A: urokinase group. Group A (M 17, F 10; age 80.11y 鹵3.17y) was treated with 100000 U urokinase combined with routine therapy (control of blood pressure, control of blood glucose, stable plaque, anti-platelet aggregation). Improvement of cerebral circulation and other risk factors were treated for 2 weeks. Group B (M 15, F 11; age 79.96 y 鹵4.31 y) was treated with routine therapy for 2 weeks. The symptom recurrence, coagulation function and average area of carotid atherosclerotic plaque before and after treatment were compared and analyzed between the two groups, so as to evaluate the clinical efficacy and safety of the treatment regimen. Results 1. The total effective rate was 13 cases in group A, 8 cases in effective group, 6 cases in ineffectiveness, 0 cases in aggravation, and 77.8% in total effective rate; In group B, there were 7 cases of remarkable effect, 5 cases of effective, 12 cases of failure and 2 cases of deterioration. The total effective rate was 46.2%. There was significant difference in total effective rate between the two groups (P < 0.05). 2the change of coagulation function: APTT,PT,INR data of group A had no significant difference before and after treatment, but there was no significant difference in APTT,PT,INR data before and after treatment in group A (P > 0. 05), but there was no significant difference in APTT,PT,INR data before and after treatment (P > 0. 05). There was no statistical significance (P > 0.05). There was no significant difference in APTT,PT,INR data between the two groups after treatment (P > 0. 05). The Fbg.,DD of group A was significantly decreased after treatment (P < 0. 05). There was no significant difference in Fbg.,DD data before and after treatment in group A (P > 0. 05). After treatment, Fbg.,DD in group A was significantly lower than that in group B (P < 0. 05). 3The mean area of carotid atherosclerotic plaque decreased significantly in group A after treatment (P < 0.05). There was no significant difference in the mean area of carotid atherosclerotic plaques before and after treatment in group B. there was no significant difference between the two groups (P > 0.05). After treatment, the mean area of carotid atherosclerotic plaques in group A was smaller than that in group B (P > 0.05). There was statistical difference (P < 0.05). 4, safety: no central nervous system or other bleeding occurred in both groups. Conclusion low dose urokinase combined with routine therapy is superior to conventional therapy in the treatment of transient cerebral ischemic attack in elderly patients, and it is safe for elderly patients because it does not increase the risk of hemorrhage in elderly patients.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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