阿加曲班联合阿司匹林治疗早期进展性缺血性脑卒中的疗效观察

Efficacy of argatroban combined with aspirin in treatment of acute ischemic stroke with early progression

目的探讨阿加曲班联合阿司匹林在早期进展性缺血性脑卒中治疗中的应用效果。方法纳入2019年1月—2022年1月火箭军特色医学中心收治的发病24 h内、未接受静脉溶栓治疗和血管内介入治疗的急性进展性缺血性脑卒中患者120例为对象进行回顾性研究。根据治疗方案的不同分为对照组(阿司匹林联合氢硫酸氯吡格雷)及试验组(阿加曲班联合阿司匹林),每组各60例。对照组口服阿司匹林肠溶片每次100 mg,每天1次,同时联合口服硫酸氢氯吡格雷片每次75 mg,每天1次,共3周。试验组予以阿司匹林肠溶片,用法用量同对照组,在此基础上联合阿加曲班注射液,治疗前48 h给予阿加曲班注射液60 mg,每天1次,24 h持续静脉泵入,第3~7天予以阿加曲班注射液每次10 mg,每天2次,3 h静脉滴注。两组住院治疗时间均≥14 d。分别采用美国国立卫生研究院卒中量表(NIHSS)评分及根据Barthel指数(BI)评分比较治疗前后两组患者神经功能缺损情况及日常生活能力改善情况,并观察两组的症状性脑出血及消化道出血等不良反应情况。结果试验组与对照组治疗的总有效率分别为82.67%和65.00%,差异有统计学意义(P<0.05)。治疗前两组NIHSS比较,差异有统计学意义(P<0.05)。治疗后两组患者NIHSS评分均较治疗前显著降低(P<0.05),试验组降低程度更加明显,治疗后两组NIHSS评分比较,差异无统计学意义(P>0.05)。治疗前,试验组BI评分低于对照组,但差异无统计学意义(P>0.05);治疗后,两组患者BI评分均较同组治疗前显著增加(P<0.05),且试验组BI评分显著高于对照组(P<0.05)。治疗期间出现消化道出血的患者对照组有3例,试验组有2例;两组患者均无症状性脑出血出现。两组间主要不良反应比较,差异无统计学意义(P>0.05)。结论阿加曲班联合阿司匹林较常规双抗治疗更有助于改善早期急性进展性缺血性脑卒中患者的神经功能预后,同时不增加不良反应风险。

Objective To investigate the effect of argatroban combined with aspirin in treatment of acute ischemic stroke with early progression.Methods A total 120 patients with early progressive acute ischemic stroke treated in The PLA Rocket Force Characteristic Medical Center from January 2019 to January 2022 without intravenous thrombolysis and endovascular interventional therapy were retrospectively studied.According to the different treatment strategies,the patients were divided into two groups:the control group(aspirin combined with clopidogrel hydrosulfate,n=60)and the experimental group(argatroban combined with aspirin,n=60).The patients in the control group received oral Aspirin Enteric Coated Tablets of 100 mg once a day,while taking Clopidogrel Sulfate Tablets of 75 mg once a day for a total of three weeks.The patients in the experimental group were given Aspirin Enteric Coated Tablets in the same dosage as those in the control group.On this basis,they were combined with Argatroban Injection.Argatroban Injection was given 60 mg,once a day,and continuously pumped intravenously for 24 h after 48 hours before treatment.Argatroban Injection was given 10 mg,twice a day,and intravenously for three hours from the 3rd to 7th days.The duration of hospitalization in both groups was≥14 days.NIHSS score and Barthel index(BI)score were used to compare the neurological deficit and the improvement of activities of daily living between the two groups before and after treatment,and the adverse reactions such as symptomatic cerebral hemorrhage and gastrointestinal hemorrhage were observed.Results The total effective rates of treatment in the experimental group and the control group were 82.67%and 65.00%,respectively,with a statistically significant difference(P<0.05).There was a statistically significant difference in NIHSS score between the two groups before treatment(P<0.05).After treatment,the NIHSS scores of patients in both groups were significantly lower than before treatment(P<0.05).The degree of reduction in the experimental group was more significant,and there was no statistically significant difference in NIHSS scores between the two groups after treatment(P>0.05).Before treatment,the BI score of the experimental group was lower than that of the control group,but the difference was not statistically significant(P>0.05).After treatment,the BI scores of patients in both groups were significantly higher than those in the same group before treatment(P<0.05),and the BI scores in the experimental group were significantly higher than those in the control group(P<0.05).During the treatment period,there were three patients with gastrointestinal bleeding in the control group and two patients in the experimental group,and no symptomatic cerebral hemorrhage occurred in both groups.There was no statistically significant difference in the main adverse reactions between the two groups(P>0.05).Conclusion Argatroban combined with aspirin is more helpful than conventional dual antiplatelet therapy in improving the neurological prognosis of patients with early acute progressive ischemic stroke without increasing the risk of adverse reactions.