直接凝血酶抑制剂辅助应用对行静脉溶栓急性进展性脑梗死患者临床疗效的影响

Effects of Direct Thrombin Inhibitors on Clinical Efficacy in Patients with Acute Progressive Cerebral Infarction Treated with Intravenous Thrombolysis

目的探讨直接凝血酶抑制剂辅助应用对行静脉溶栓急性进展性脑梗死患者临床疗效的影响。方法选取我院2016年3月～2017年12月收治急性进展性脑梗死患者共100例,以随机数字表法分为对照组(50例)和观察组(50例),分别在常规对症干预基础上给予阿替普酶和阿替普酶+阿加曲班方案治疗;比较两组患者临床疗效,治疗前后NIHSS评分、mRS评分、ADL-Barthel指数评分、脑血流动力学指标、血液流变学指标、炎性细胞因子、NT-proBNP及Hcy水平。结果观察组患者临床疗效显著优于对照组,差异有统计学意义(P<0. 05);观察组患者治疗后NIHSS、mRS及ADL-Barthel指数评分均显著优于对照组、治疗前,差异有统计学意义(P<0. 05);观察组患者治疗后脑血流动力学指标和血液流变学指标水平均显著优于对照组、治疗前,差异有统计学意义(P<0. 05);观察组患者治疗后TNF-α、IL-6、NT-proBNP及Hcy水平均显著低于对照组、治疗前,差异有统计学意义(P<0. 05)。结论直接凝血酶抑制剂辅助治疗急性进展性脑梗死可有效控制神经功能损伤进展,改善脑血流动力学和血液流变学状态,并有助于下调炎性细胞因子、NT-proBNP及Hcy水平。

Objective To investigate the effect of direct thrombin inhibitors on clinical efficacy in patients with acute progressive cerebral infarction treated with intravenous thrombolysis.Methods 100patients with acute progressive cerebral infarction admitted to our hospital from March 2016to December 2017were selected.The patients were divided into control group(50cases)and observation group(50cases)by random number table method which were given rt-PA and rt-PA combined Argatroban respectively on the basis of conventional symptomatic intervention.The clinical efficacy of the two groups,NIHSS score,mRS score,ADL-Barthel index score,cerebral hemodynamics index,hemorheology index,inflammatory cytokines,NT-proBNP and Hcy levels were compared before and after treatment.Results The clinical efficacy of the observation group was significantly better than that of the control group(P<0.05).The NIHSS,mRS and ADL-Barthel index scores in the observation group after treatment were significantly better than those in the control group before treatment(P<0.05).Cerebral hemodynamic indexes and hemorheological indexes in the observation group after treatment were significantly better than those in the control group before treatment(P<0.05).The levels of TNF-α,IL-6,NT-proBNP and Hcy in the observation group after treatment were significantly lower than those in the control group before treatment(P<0.05).Conclusion Direct thrombin inhibitor as adjuvant treatment of acute progressive cerebral infarction can effectively control the progression of neurologic function injury,improve cerebral hemodynamics and hemorheology and down-regulate inflammatory cytokines,NT-proBNP and Hcy levels.