阿加曲班、氯吡格雷与丁苯酞联合治疗进展性脑梗死的疗效及安全性研究

Efficacy and safety of combined use of argatroban and clopidogrel and butylphthalide in the treatment of progressive cerebral infarction

目的:探讨阿加曲班、氯吡格雷与丁苯酞联合治疗进展性脑梗死(PCI)的疗效及安全性。方法:根据患者的意愿和实际情况,将90例PCI患者分为对照组(40例)和观察组(50例)。对照组给予阿加曲班加氯吡格雷,而观察组给予阿加曲班加氯吡格雷加丁苯酞。采用美国国立卫生研究院脑卒中量表(NIHSS)、Barthel指数(BI)和改良Rankin量表(mRS)评价两组的神经功能缺损程度、日常生活能力和神经功能恢复状况。检测两组的炎性因子浓度和脑血流动力学指标。结果:观察组总有效率明显高于对照组(P<0.05)。在治疗后14、30、90d时,观察组的NIHSS评分明显低于对照组,而BI评分则明显高于对照组(P<0.05)。观察组的治疗90dmRS评分明显低于对照组(P<0.05)。在治疗后30d时,观察组的TNF-α、IL-6和hs-CRP均明显低于对照组组,观察组的锋流速和平均流速均明显快于对照组,观察组的锋流速差和平均流速差则明显小于对照组(P<0.05)。结论:采用阿加曲班、氯吡格雷与丁苯酞联合治疗PCI可提高总有效率、日常生活能力和预后,同时可减轻神经功能缺损、缓解炎症反应和纠正脑血流动力异常。

Objective： Investigate the efficacy and safety of combined use of argatroban, clopidogrel and bu- tylphthalide in the treatment of progressive cerebral infarction （PCI）. Method： Ninety patients with PCI were divided into observation group （40 cases） and control group （50 cases） according to the patienfs wishes and the actual situation. The control group was treated with argatroban-^-clopidogrel,and the observation group was treated with argatroban＋clopidogrel＋-butylphthalide. Neurological deficits, activities of daily living and recovery of neurological function were assessed between two groups using the national institutes of health stroke scale （NIHSS）, barthel index （BI） and modified rankin scale （mRS）. The concentration of inflammatory factors and the indexes of cerebral hemodynamics in the two groups were detected. Result：The total effective rate of the observation group was signif- icantly higher than that of the control group （P〈0.05）. The NIHSS score of the observation group was significantly lower than that of the control group, while the BI score was significantly higher than that of the control group at after treatment of 14 d,30 d and 90 d （P〈0.05）. The scores of mRS in the observation group were lower than those in the control group at the after treatment of 90 d （P〈0.05）. After treatment 30 d,the levels of TNF- α,IL-6 and hs-CRP in the observation group were significantly lower than those in the control group, the frontal velocity and mean flow velocity of the observation group were significantly faster than those of the control group, and the frontal velocity difference and mean velocity difference of the observation group were significantly smaller than those of the control group （P〈 0. 05）. Conclusion： The combined use of argatroban, clopidogrel and butylphthalide in the treatment of PCI can improve the total effective rate, ability of daily living and prognosis, and at the same time, it also can relieve neurological deficits, alleviate inflammatory reaction and correct abnormal cerebral blood flow.