低分子肝素治疗伴低INR的颈动脉粥样硬化斑块疗效探讨.DOCVIP

临床医学论文-低分子肝素治疗伴低INR的颈动脉粥样硬化斑块疗效探讨 【摘要】? 目的 低分子肝素治疗伴低INR的颈动脉粥样硬化斑块的临床疗效探讨。方法 70例入选患者随机分为两组：治疗组34例（低分子肝素＋内科综合治疗），对照组36例（内科综合治疗）。入组患者均于治疗前后进行INR、颈动脉彩色多普勒超声检查，同时进行颈动脉粥样硬化斑块内膜－中层厚度（IMT）、颈动脉斑块积分评估。结果 两组治疗后均能提高INR，组间相比显示治疗组疗效优于对照组（P0.05）；治疗组降低IMT和颈动脉斑块积分有明显差异（P0.05）。结论 低分子肝素治疗伴低INR的颈动脉粥样硬化斑块疗效优于内科综合治疗。 【关键词】? 低分子肝素　INR　颈动脉粥样硬化斑块 ????? 【Abstract】? Objective? To investigate the clinical effect of Lowmolecular weight heparin(LMWH) on carotid arteriosclerosis with low-INR. Methods? 70 cases were randomly divided into two groups. The treatment group (n=34)was treated with LMWH and medical comprehensive treatment, the control group(n=36) was treated only with medical comprehensive treatment. All the cases were given the examination of INR, CDI of carotid,the measure of fasting blood lipid level and carotid artery plaque intima-media thickness before and after?the treatments. Results?INR was improved after the two treatments in both groups. But?the rapeutic effect?was better in the LMWH treatment group than that in the control group(P0.05);The effect on reducing the measure of INT and carotid artery plaque intima-media thickness in the treatment group was superior to that in the control group(P0.05).?Conclusion?The effect of LMWH is better than medical comprehensive treatment on carotid arteriosclerosis with low-INR. ??? 【Key words】? low molecular weight heparin;???? INR;??? carotid arteriosclerosis ??? 缺血性脑血管疾病是中老年人的常见病，具有很高的致残率。颈动脉粥样硬化及斑块形成是引起缺血性脑血管病的主要危险因素之一。同时，颈动脉粥样硬化斑块的干预治疗，对于缺血性脑卒中一、二级预防有重要意义。本研究通过测定脑梗死患者颈动脉粥样硬化斑块治疗前后内膜－中层厚度（IMT）以及颈动脉斑块积分的变化，探讨低分子肝素对伴低INR的颈动脉粥样硬化斑块的治疗作用。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 病例采集自2004年1月～2007年12月本院神经内科住院的急性脑梗死病人，共70例。其中男37例，女33例；年龄47～80岁，平均69.2±11.4岁。脑梗死患者均符合国家第四届脑血管病学术会议制订的标准［1］，并经头颅CT或MRI扫描证实。患者均经彩色多普勒超声检查证实存在颈动脉粥样硬化斑块。 ??? 1.2? 应用低分子肝素的指征及反指征? 发病时间12h、INR0.82（INR正常值0.82～1.15）。有出血病史和出血倾向、血小板计数 100 ×109/ L、严重高血压(SBP 180mmHg 或DBP 120mmHg)、心源性脑梗死、TIA 发作、CT或MRI 证实为脑出血、出血性脑梗死或大面积梗死、已用抗凝剂或抗纤溶剂、严重心肝肾功能不全者均不在入选内。 ??? 1.3? 颈动脉彩色多普勒超声评价标准? 采用我院西门子AC