阿加曲班联合阿替普酶治疗急性缺血性脑卒中的临床疗效及安全性研究

Clinical efficacy and safety of argatroban combined with alteplase in treatment of acute ischemic stroke

目的探讨阿替普酶联合阿加曲班治疗急性缺血性脑卒中的治疗效果以及风险性。方法采用回顾性分析方法,选取2019年6月-2020年6月邢台市第三医院收治的在溶栓时间窗的急性缺血性脑卒中患者100例作为研究对象,根据治疗方法将患者分为对照组(n=50)和观察组(n=50)。两组患者均给予常规基础治疗,对照组给予注射用阿替普酶静脉溶栓治疗,按照0.9 mg/kg(最大剂量为90 mg)给药,其中10%于1 min内静脉推注完毕,其余90%药液在1 h内静脉泵入。溶栓24 h后复查头颅CT无出血后,给予阿司匹林治疗。观察组在对照组基础上加用阿加曲班注射液治疗,第1~2天予以60 mg/d阿加曲班稀释后持续静脉泵注(速度2.5 mg/h),其后阿加曲班注射液10 mg于生理盐水20 mL中持续静脉泵入3 h,2次/d。两组均持续治疗7 d。记录两组患者治疗前及溶栓后1 h、治疗后7 d、治疗后3个月的美国国立卫生研究院卒中量表(NIHSS)评分以及治疗前及治疗后3个月改良Rankin量表(mRS)评分,记录治疗期间不良反应发生情况。结果治疗后,观察组总有效率为90.0%,显著高于对照组的74.0%(P<0.05)。治疗后,两组NIHSS、mRS评分均改善,观察组治疗后3个月NIHSS评分和mRS评分均显著低于对照组(P<0.05、0.01)。两组治疗期间不良反应总发生率比较差异无统计学意义。结论阿替普酶联合阿加曲班治疗急性缺血性脑卒中临床效果显著,能有效减轻患者神经功能受损症状,提高生活质量且安全性良好,值得临床应用推广。

Objective To investigate the therapeutic effect and risk of alteplase combined with argatroban in the treatment of acute ischemic stroke.Methods 100 patients with acute ischemic stroke in thrombolysis time window treated in Xingtai Third Hospital from June 2019 to June 2020 were selected as the research objects.According to the treatment methods,the patients were divided into control group(n=50)and observation group(n=50).The patients in both groups were given routine basic treatment.The control group was given intravenous thrombolysis with alteplase for injection at the dose of 0.9 mg/kg(the maximum dose was 90 mg),of which 10%were injected intravenously within 1 min,and the other 90%were pumped intravenously within 1 h.After 24 h of thrombolysis,the patients were given aspirin treatment after reexamination of cranial CT without bleeding.Patients in the observation group were treated with Argatroban Injection on the basis of the control group.On the first to second days,60 mg/d argatroban was diluted and continuously pumped intravenously(at a rate of 2.5 mg/h),and then 10 mg argatroban was continuously pumped intravenously in 20 mL normal saline for 3 h,twice a day.Patients in both groups were treated for seven days.The National Institutes of Health Stroke Scale(NIHSS)scores and the modified Rankin Scale(mRS)scores before and 3 months after treatment were recorded.The adverse reactions during treatment were recorded.Results After treatment,the total effective rate in the observation group was 90.0%,significantly higher than 74.0%in the control group(P<0.05).After treatment,the NIHSS and mRS scores of the two groups were improved.The NIHSS and mRS scores of the observation group were significantly lower than those of the control group three months after treatment(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups.Conclusion The clinical effect of alteplase combined with argatroban in the treatment of acute ischemic stroke is significant.It can effectively reduce the symptoms of impaired neurological function,improve the quality of life,and has good safety.It is worthy of clinical application and promotion.