阿加曲班联合依达拉奉治疗老年急性脑梗死的临床疗效及其对凝血功能、血管内皮功能的影响

Effect of agatroban combined with edaravone in the treatment of elderly patients with acute cerebral infarction and the impact on coagulation function and vascular endothelial function

目的探讨阿加曲班联合依达拉奉治疗老年急性脑梗死患者的临床疗效及其对凝血功能、血管内皮功能的影响。方法将惠安县医院2018年1—10月收治的90例老年急性脑梗死患者按随机数字表法分为对照组45例和观察组45例。患者均采用常规治疗,其中对照组患者给予依达拉奉治疗,观察组患者在对照组基础上加用阿加曲班治疗,2组均连续给药14 d。比较2组临床疗效,治疗前及治疗14 d后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数量表(BI)评分、炎性因子[超敏C反应蛋白(hs-CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)]、血管内皮功能指标[一氧化氮(NO)、内皮素1(ET-1)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)],不良反应发生率。结果观察组临床总有效率为93.33%,高于对照组的75.56%(χ^(2)=5.414,P<0.05)。与治疗前相比,2组治疗14 d后BI评分及NO水平升高,NIHSS评分及hs-CRP、IL-6、TNF-α、ET-1水平降低(P<0.01);观察组治疗14 d后BI评分及NO水平较对照组高,NIHSS评分及hs-CRP、IL-6、TNF-α、ET-1水平较对照组低(P<0.01)。与治疗前相比,2组治疗14 d后APTT缩短,TT、PT延长,Fib水平降低(P<0.01);观察组治疗14 d后APTT较对照组短,TT、PT较对照组长,Fib水平较对照组低(P<0.01)。2组患者在治疗过程中均未见明显不良反应。结论依达拉奉联合阿加曲班治疗老年急性脑梗死患者能够提高临床效果,除可增强抗凝作用外,还可减轻机体炎性反应及血管内皮功能损伤,改善神经功能,提高患者日常生活能力,且安全性较高。

Objective To investigate the effect of argatroban combined with edaravone on treating elderly patients with acute cerebral infarction and the impact on coagulation function and vascular endothelial function.Methods 90 cases of elderly patients with acute cerebral infarction admitted to Hui′an County Hospital from January to October 2018 were divided into control group(45 cases)and observation group(45 cases)according to random number table method.Both groups of patients were given conventional treatment,while patients in the control group were given edaravone,and patients in the observation group were given agatroban on the basis of the control group,all patients were treated for 14 days.Clinical effect,NIHSS score,BI score,inflammatory factors(hs-CRP,IL-6,TNF-α),vascular endothelial function indexes(NO,ET-1),coagulation function indexes(PT,APTT,TT,Fib)before treatment and at 14 days after treatment,incidence of adverse reactions were compared between the two groups.Results Total effective rate of observation group was 93.33%,which was higher than 75.56%of control group(χ^(2)=5.414,P<0.05).Compared with those before treatment,BI score and NO level at 14 days after treatment of the two groups were elevated,NIHSS score and levels of hs-CRP,IL-6,TNF-α,ET-1 were decreased(P<0.01);BI score and NO level at 14 days after treatment of the observation group were higher than those in control group,NIHSS score and levels of hs-CRP,IL-6,TNF-α,ET-1 were lower than those in control group(P<0.01).Compared with those before treatment,APTT at 14 days after treatment of the two groups were shorten,TT,PT were lengthen,Fib level was decreased(P<0.01);and APTT at 14 days after treatment of the observation group was shorter than that in control group,TT,PT were longer than those in control group,Fib level was lower than that in control group(P<0.01).There was no obviously adverse reactions happened of the two groups.Conclusion Edaravone plus agatroban can improve the clinical effect for elderly patients with acute cerebral infarction,which is not only improve its anticoagulant effect,but also closely to reduce inflammatory response and vascular endothelial function damage,improve neurological function,promote daily living ability,and with higher safety.