目的 觀察阿加曲班聯(lián)合阿司匹林治療穿支動脈病變型進展性腦梗死的臨床療效。方法 選取2018年1月-2020年12月天津市中醫(yī)藥研究院附屬醫(yī)院針灸病房收治的120例穿支動脈病變型進展性腦梗死患者,根據(jù)隨機數(shù)字表法將患者分為對照組和治療組,每組各60例,剔除脫落病例(n=9)后剩余對照組56例,治療組55例。對照組口服阿司匹林腸溶片,100 mg/次,1次/d。治療組在對照組治療基礎(chǔ)上靜脈滴注阿加曲班注射液,60 mg/d適當輸液稀釋,持續(xù)靜脈滴注48h;后減量至20mg/d,2次/d,靜脈滴注12 d。兩組均治療14 d。觀察兩組的臨床療效,比較兩組美國國立衛(wèi)生研究院卒中量表(NIHSS)評分、Barthel指數(shù)、血漿脂蛋白磷脂酶A₂(LP-PLA₂)、D-二聚體(D-dimer)和活化部分凝血活酶時間(APTT)。結(jié)果 治療后,治療組總有效率是81.82%,顯著高于對照組的62.50%(P<0.05)。治療后,兩組NIHSS評分顯著下降,Barthel指數(shù)較顯著升高(P<0.05),其中治療組NIHSS評分顯著低于對照組,Barthel指數(shù)顯著高于對照組,兩組間比較差異有統(tǒng)計學意義(P<0.05)。治療后,兩組LP-PLA₂、D-dimer顯著降低,APTT顯著延長(P<0.05),其中治療組治療后LP-PLA₂、D-dimer顯著低于對照組,APTT顯著長于對照組(P<0.05)。結(jié)論 阿加曲班聯(lián)合阿司匹林治療穿支動脈病變型進展性腦梗死具有良好的療效,可改善患者的神經(jīng)功能和血液高凝狀態(tài),提高患者的生活能力,且安全性高。

Objective To observe the clinical efficacy of argatroban combined with aspirin in treatment of progressive cerebral infarction caused by perforator artery lesions. Methods A total of 120 patients with progressive cerebral infarction with perforating artery lesions treated in the acupuncture ward of Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from January 2018 to December 2020 were selected. According to the random number table method, the patients were divided into control group and treatment group, with 60 cases in each group. After removing the detached cases (n=9), there were 56 cases in the control group and 55 cases in the treatment group. Patients in the control group were po administered with Aspirin Enteric-coated Tablets, 100 mg/time, once daily. Patients in the treatment group were iv administered with Argatroban Injection on the basis of the control group, 60 mg/d was diluted with appropriate infusion and continued intravenous infusion for 48 h. Then the dosage was reduced to 20 mg/d, twice daily, and intravenous infusion was given for 12 d. Both groups were treated for 14 d. The clinical efficacy of the two groups were observed, and the scores of national Institutes of Health Stroke Scale (NIHSS), Barthel index, plasma lipoprotein phospholipase A₂ (LP-PLA₂), D-dimer and activated partial thrombin time (APTT) were compared between the two groups. Results After treatment, the total effective rate of treatment group was 81.82%, significantly higher than that of control group 62.50% (P < 0.05). After treatment, NIHSS score was significantly decreased, but Barthel index was significantly increased in both groups (P < 0.05). NIHSS score in the treatment group was significantly lower than that in the control group, but Barthel index was significantly higher than that in the control group, with statistically significant differences between the two groups (P < 0.05). After treatment, LP-PLA₂ and D-Dimer in the two groups were significantly decreased, while APTT was significantly increased (P < 0.05). LP-PLA₂ and D-Dimer in the treatment group were significantly lower than those in the control group, but APTT was significantly higher than those in the control group (P < 0.05). Conclusion Agaltreban combined with aspirin has good efficacy in treatment of progressive cerebral infarction with perforator artery lesions, and can improve patients' neurological function and blood hypercoagulability, and improve their living ability with high safety.

R971