| Objective:To discuss the anti-inflammatory efficacy of early-use of Low-Molecular-Weight Heparin to the acute cerebral infarction(ACI) after systemic inflammatory response syndrome(SIRS), reduce the incidence of multiple organ dysfunction syndrome(MODS),and improve the prognosis.Methods: 317 inpatients of ACI were collected,91 patients suffered from SIRS, and 83 patients who met the all kinds of standards,were randomly divided into LMWH treatment group(42 cases) and conventional treatment group(41 cases),basing on the conventional anti-platelet aggregation, nutrition,brain cells and symptomatic treatment(Conventional treatment group),LMWH treatment group were another injected Low-Molecular-Weight Heparin 5000 IU subcutaneous,once daily,for 10 days.Then detecting the index of fasting blood interleukin-1β(IL-1β), interleukin-6(IL-6), tumor necrosis factor(TNF-α),endotoxin, high-sensitivity C-reactive protein(hs-CRP) and coagulation parameters,at the seventh and fourteenth days before and after the treatment,assessed the incidence of MODS,and while compared the bleeding tendencies.Results: 1. 317 patients of ACI, 91 patients with SIRS, the incidence of ACI after SIRS were 28.71%.2. Clinical data and comparability of observations(LMWH treatment group and the conventional therapy group):comparing the sex,average age and NIHSS scores of LMWH treatment group and conventional therapy group,there were no significant difference(P>0.05);LMWH treatment group and conventional therapy group,before treatment,were no significant difference(P> 0.05)in all determination index of SIRS;comparing the index of serum IL-1β, IL-6, TNF-α, endotoxin, CRP and coagulation parameters of LMWH treatment group and conventional therapy group,there were no significant difference(P> 0.05) before the treatment;3.the incidence of MODS(LMWH treatment group and the conventional therapy group):the incidence of LMWH treatment group(50.0%)was significantly lower than the conventional treatment group(73.1%)(P <0.05).4. The levels of serum IL-1β, after treatment,(LMWH treatment group and the conventional therapy group): the levels of serum IL-1β of LMWH treatment group at the 7and 14 days,after treatment,were 344.13±19.40, 233.06±19.77 ng / L,and the levels of serum IL-1βof the conventional therapy group at the 7 and 14 days,after treatment,were 406.32±26.50, 328.71±16.01ng/L,the LMWH treatment group significantly lower than the conventional treatment group,statistically significant(P <0.05).5. The levels of serum IL-6, after treatment,(LMWH treatment group and the conventional therapy group): the levels of serum IL-6 of LMWH treatment group at the 7 and 14 days,after treatment,were 68.09±15.61, 46.03±10.77ng/L,and the levels of serum IL-6 of the conventional therapy group at the 7 and 14 days,after treatment,were76.36±10.46, 57.09±14.44ng/L,the LMWH treatment group significantly lower than the conventional treatment group, statistically significant(P <0.05).6. The levels of serum TNF-α, after treatment,(LMWH treatment group and the conventional therapy group): the levels of serum TNF-α of LMWH treatment group at the 7 and 14 days,after treatment,were 35.58±5.86, 19.88±3.59 ng/L,and the levels of serum TNF- αof the conventional therapy group at the 7and 14 days,after treatment,were 38.55±3.86, 25.38±2.45ng/L,the LMWH treatment group significantly lower than the conventional treatment group,statistically significant(P <0.05).7. The levels of serum Endotoxin, after treatment,(LMWH treatment group and the conventional therapy group): the levels of serum Endotoxin of LMWH treatment group at the 7 and 14 days,after treatment,were 65.84±7.95, 54.16±6.95ng/L,and the levels of serum Endotoxin of the conventional therapy group at the 7 and 14 days,after treatment,were68.77±6.60, 58.40±5.85ng/L,the LMWH treatment group significantly lower than the conventional treatment group, statistically significant(P <0.05).8. The levels of serum hs-CRP, after treatment,(LMWH treatment group and the conventional therapy group): the levels of serum hs-CRP of LMWH treatment group at the 7 and 14 days,after treatment,were 11.80±8.26, 9.02±3.32mg/L,and the levels of serum hs-CRP of the conventional therapy group at the 7 and 14 days,after treatment,were17.94±5.56, 14.21±5.08 mg/L,the LMWH treatment group significantly lower than the conventional treatment group, statistically significant(P <0.05).9. The levels of serum Coagulation, after treatment,(LMWH treatment group and the conventional therapy group): the levels of serum Activated partial thromboplastin time(APTT) of LMWH treatment group at the 7 and 14 days,after treatment,were 42.36±2.02, 41.69± 1.90 sec,Prothrombin time(PT) were 15.22±1.00, 14.73±1.06 sec, Fibrinogen(FIB)were3.00±0.47, 3.47±0.16g/L,PLT were 118.02±16.15, 120.25±19.07× 10^9/L;the levels of serum APTT of the conventional therapy group at the 7 and 14 days,after treatment, 42.26±1.94, 41.58±2.01 sec,PT were 15.25±1.15, 14.74±0.92 sec,FIB were2.96±0.38, 3.50±0.18g/L,PLT were 118.031±13.88, 120.38±14.57×10^9/L,Comparing the group,were not statistically significant(P > 0.05).10. The negative response of LMWH treatment group and the conventional therapy group,after treatment: during treatment of LMWH treatment group,there were four cases of bleeding gums,two cases of subcutaneous hemorrhage, one case of urinary tract bleeding,and in the conventional treatment group,there were two cases of bleeding gums,three cases of ubcutaneous hemorrhage and one case of gastrointestinal bleeding, but the two group were no fatal bleeding.Conclusions: 1. there were high incidence of ACI induce SIRS, the incidence of MODS after ACI SIRS were high, and the IL-1β, IL-6,TNF-α, endotoxin, hs-CRP involved in the pathophysiological process of ACI after SIRS. 2. LMWH can reduce the incidence of MODS in ACI after SIRS.3.The mechanism of LMWH inhibiting the incidence ACI after SIRS maybe inhibited the release of the inflammatory mediators IL-1β, IL-6, TNF-α, LPS,hs-CRP and blocked the development of SIRS to MODS. 4. It was no significant effect on blood coagulation function to use LMWH,and did not increase the risk of bleeding,so it is relative safety in the clinical application. |
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