急性脑梗死患者阿加曲班治疗对血小板功能的影响

Effect of argatroban on platelet function in acute cerebral infarction patients

①目的探讨急性脑梗死患者应用阿加曲班抗凝血酶治疗对血小板功能的影响。②方法将符合入组标准的急性脑梗死患者120例分为阿加曲班组（60例）和氯吡格雷对照组（60例）。两组患者入院给予脑梗死基础治疗，阿加曲班治疗组予以阿加曲班60mg/d，生理盐水1000mL稀释，43mL/h静脉泵入，持续维持48h；第3～7d改为阿加曲班10mg/d，生理盐水250mL稀释，90mL/h静脉泵入，2次/d；抗凝治疗结束后第8天加口服氯吡格雷75mg/d。对照组入院即刻给予氯吡格雷75mg/d 抗血小板聚集治疗。测定两组治疗前后次日晨、48 h、第7d、14d的血小板聚集率（PA），并观察治疗前后活化部分凝血酶时间、血小板计数的变化。③结果阿加曲班组抗凝血酶治疗后第2d、1周较治疗前血小板聚集率明显升高，治疗后第14d 血小板聚集率明显低于治疗前（ P ＜0．01）。对照组氯吡格雷治疗后次日晨、第7d、14dPA明显低于治疗前（ P ＜0．01）。阿加曲班组治疗前同治疗后次日晨、第7dPA差值与对照组治疗前同治疗后次日晨、第7dPA差值比较，差异有统计学意义（ P ＜0．01）。④结论应用阿加曲班抗凝治疗急性脑梗死患者 ADP 诱导的 PA 增加，治疗14d 后血小板计数和APTT较治疗前无差异。

Objective To study effect of argatroban anticoagulation on platelet function and its probable mechanisms in acute cerebral infarction .Methods One hundred twenty acute cerebral infarction patients were assigned to argatroban therapy group （ 60 cases）and clopidogrel therapy group （60 cases）.A1l patients received the basic treatment for acute cerebra 1 infarction.Patients in ar-gatroban therapy group received continuous intravenous argatroban on first forty -eight hours（60mg/d）.intravenous injection of ar-gatroban 10 mg twice a day for the next 5 days,then received clopidogrel 75mg/d after argatroban therapy .Patients in clopidogrel therapy group only received clopidogrel 75mg everyday.The platelet aggregation（PA）was measured at baseline and the second morn-ing,48 hour,7 day,and 14 day.The platelet count and activated partial thromboplastin time at baseline and on 14 day were observed . Results PA was significantly higher at 48hour and on 7 day than baseline in patients of argatroban therapy group （ P ＆lt;0.01）,while it was significantly lower on the second day inorning .the 7 day and the 1 4 day than baseline in patients of clopidogrel therapy group （ P ＆lt;0.01）.The PA difference between the second morning .the 7 day after therapy and before therapy in argtroban therapy group was significantly different from that in clopidogrel therapy group （ P ＆lt;0.01）.Conclusion Application of argatroban therapy in pa-tients with acute cerebral infarcation ,PA increase induced by ADP ,platelet count and APTT was days after treatment no difference before treatment .