静脉溶栓后神经功能恶化的治疗观察

Treatment of neurologic deterioration after intravenous thrombolysis

目的探讨抗凝和抗血小板聚集治疗脑梗死静脉溶栓后神经功能恶化的疗效。方法收集自2015年1月至2019年12月在石家庄市第一医院神经内科经静脉溶栓后神经功能恶化的62例急性脑梗死患者,行头颅CT除外出血转化后随机分为治疗组和对照组,各31例,治疗组采用单抗加抗凝,即阿加曲班联合氯吡格雷治疗,对照组采用双抗,即阿司匹林联合氯吡格雷治疗,比较两组治疗静脉溶栓后神经功能恶化的临床疗效及不良反应情况。结果治疗14天后治疗组NIHSS评分较对照组偏低(P<0.05),治疗组mRS评分亦低于对照组(P<0.05)。治疗组发生消化道出血1例,恶心、呕吐1例,对照组发生消化道出血1例,恶心、呕吐2例,对照组和治疗组不良反应的差异不显著。结论采用阿加曲班联合氯吡格雷治疗,减轻静脉溶栓后神经功能恶化症状,减轻残疾程度,疗效显著,且不会出现严重不良反应,安全可靠。

Objective To investigate the effect of anticoagulation and antiplatelet aggregation in the treatment of neurologic deterioration after intravenous thrombolysis of cerebral infarction.Methods From January 2015 to December 2019,62 patients with acute cerebral infarction were randomly divided into two groups:treatment group and control group.The treatment group was treated with single antiplatelet plus anticoagulant,i.e.agatraban combined with clopidogrel;while the control group was treated with dual antiplatelet,i.e.aspirin combined with clopidogrel.Clinical efficacy of neurological deterioration and adverse reactions were compared between the two groups after intravenous thrombolysis.Results After 14 days of treatment,NIHSS and mRS scores of the treatment group were lower than those of the control group(P<0.05).There was no significant difference in adverse reactions between the two groups.Conclusion The combination of agatraban and clopidogrel can reduce the symptoms of neurological deterioration after intravenous thrombolysis and diminish the degree of disability.The curative effect is significant,and it is safe and reliable without serious adverse reactions.