阿加曲班配合高压氧对老年缺血性脑卒中患者的Barthel指数、神经认知功能评分及血液流变学的影响

Combined Effects of Argatroban and Hyperbaric Oxygen Therapy on the Barthel Index,Neurocognitive Function and Blood Rheology in Aged Patients with Ischemic Stroke

目的探讨阿加曲班配合高压氧疗对老年缺血性脑卒中（ischemicstroke，IS）的临床效果及其对Barthel指数、神经认知功能评分及血液流变学的影响。方法以2009年4月～2012年10月期间于笔者医院神经内科住院就诊的86例Is患者为研究对象，采用随机数字表法分为对照组和观察组，每组各43例，其中对照组仅给予阿加曲班，观察组则在此基础之上加用高压氧疗。比较两组患者的临床疗效、Barthel指数、神经认知功能评分及血液流变学指标。结果观察组患者在平均住院天数和平均住院费用均显著低于对照组（P〈0．05）；治疗前两组患者的HDS评分、NIHSS评分、Barthel指数和血液流变学指标全血黏度切变率、血浆黏度、相对血液黏度切变率、血细胞比容、纤维蛋白原比较，差异均无统计学意义（P〉0．05）；但治疗结束后，两组患者的HDS评分和Barthel指数显著增高，NIHSS评分、全血黏度切变率、血浆黏度、相对血液黏度切变率和纤维蛋白原均明显下降（P〈0．05）；而且，观察组患者的改善程度明显优于对照组，差异均具有统计学意义（P〈0．05）。结论阿加曲班配合高压氧对老年IS患者具有显著临床疗效，并能改善其自理生活能力、认知功能，降低血液黏度。

Objective To Investigate the combination of argatroban and hyperbaric oxygen therapy on the Barthel index, neurocogni- rive function and blood rheology in elderly patients with ischemic stroke （IS）. Methods The 86 cases with IS obtained from 2009 April to 2012 October in our hospital at department of internal neurology were selected as the research object and randomly divided into control group and observation group, with 43 cases in each group. Patints in the control group received argatroban, while the patients in observa- tion group were given hyperbaric oxygen therapy combined with argatroban. Barthel index, neurocognitive function score and blood rheolo- gy were compared between two groups. Results In the observation group, the average hospitalization days and the average hospitalization expenses were significantly lower than those of the control group （P 〈 0.05）. Before treatment, HDS score, NIHSS score, Barthel index and hemorheology blood viscosity shear rate, plasma viscosity, relative viscosity of blood shear rate, hematocrit, fibrinogen showed no sig- nificant difference between two groups （P 〉 0.05）. However, at the end of treatment, HDS score and the Barthel index were significantly increased, NIHSS score, blood viscosity, plasma viscosity, shear rate, shear rate relative blood viscosity and fibrinogen were significantly decreased （P 〈 0.05 ）. Moreover, the improvements of the patients in observation group were significantly better than those in the control group （ P 〈 0.05）. Conclusion Argatroban combined with hyperbaric oxygen has a significant therapeutic effect on elderly patients with IS, and can improve their self-care ability, cognitive function, reduce blood viscosity.