大剂量低分子肝素联合尿激酶序贯治疗颅内静脉窦血栓的疗效及安全性研究

摘要

Objective To study the efficacy and safety of large dose LMWH with urokinase sequential thera-py for intracranial venous sinus thrombosis.Methods Ninety-seven patients with intracranial venous sinus thrombosis were selected, according to different anticoagulation therapies and divided into 3 groups, experimental A group ( 33 cases), using large dose of LMWH(5 000 U, twice/d) with urokinase(100 000 U, once/d) sequential therapy, ex-perimental B group(32 cases), using low dose of LMWH(5 000 U, once/d) with urokinase(100 000 U, once/d) sequential therapy, control group(32 cases), using warfarin 2.5 mg, qd, P.O.Therapeutic effects and adverse re-actions in all groups were compared.Results The efficient rate and sinus revascularization rate of experimental A group were the highest.Followed were respectively experimental B group and the control group(P<0.05).Before the treatment, there was no significant difference in the average intracranial pressure among the three groups ( P>0.05).After 3 or 6 months′treatment, the average intracranial pressure of experimental A or B group was obviously lower than that of the control group and pre-therapy(P<0.05).There was significant difference between the experi-mental A and B group ( P<0.05 ) .The highest recovery rate and the lowest mortality rate were in experimental A group.Followed was experimental B group.The lowest recovery rate and the highest mortality rate were in the control group( P<0.05 ) .There was no significant difference in the extracranial blood rate among the three groups ( P>0.05).After symptomatic treatment all were relieved.Conclusion A large dose of LMWH with urokinase sequential therapy is efficient for intracranial venous sinus thrombosis.It can enhance thrombosis absorption, increase venous si-nus revascularization, reduce intracranial pressure and improve prognosis.%目的：探讨大剂量低分子肝素联合尿激酶序贯治疗颅内静脉窦血栓的疗效及安全性。方法选取该院颅内静脉窦血栓患者97例，根据不同抗凝治疗方案将患者分为三组：试验A组33例采用大剂量低分子肝素（5000 U，2次／d）联合尿激酶（10万U，1次／d）序贯治疗；试验B组32例采用低剂量低分子肝素（5000 U，1次／d）联合尿激酶（10万U，1次／d）序贯治疗；对照组32例采用口服华法林治疗（2.5 mg，1次／d），比较三组治疗效果和不良反应的差异。结果三组治疗有效率和静脉窦再通率比较发现，试验A组最高，其次为试验B组，对照组最低，差异具有统计学意义（ P＜0.05）；治疗前组间平均颅内压比较差异无统计学意义（ P＞0.05），治疗后3、6个月，试验A、B组平均颅内压明显低于对照组和治疗前（P＜0.05），且试验A、B组间比较差异亦具有统计学意义（ P＜0.05）；试验A组疾病恢复率最高，病死率最低，其次为试验B组，而对照组疾病恢复率最低，病死率最高，差异具有统计学意义（P＜0.05）；组间颅外出血率比较差异无统计学意义（P＞0.05），经对症处理后缓解。结论大剂量低分子肝素联合尿激酶序贯治疗颅内静脉窦血栓疗效显著，药物通过可增强血栓吸收、提高静脉窦再通率、降低颅内压和改善疾病预后，且药物安全性高，值得临床推广应用。