目的 探究阿加曲班對(duì)急性缺血性腦卒中患者腦側(cè)支血流、炎癥因子及血管內(nèi)皮功能以及預(yù)后的影響。方法 回顧性選取2018年2月—2020年3月徐州市腫瘤醫(yī)院收治的96例急性缺血性腦卒中患者為研究對(duì)象，根據(jù)治療方法不同將患者分為對(duì)照組和試驗(yàn)組，每組各48例，對(duì)照組采用常規(guī)治療方法治療，試驗(yàn)組患者在常規(guī)治療的基礎(chǔ)上加用阿加曲班注射液，第1～2天，阿加曲班注射液60 mg加入500 mL 0.9%氯化鈉注射液中，24 h由輸注泵持續(xù)泵入；第3～5天，10 mg阿加曲班注射液加入100 mL 0.9%氯化鈉注射液中，輸注泵3 h內(nèi)輸注完畢，每天2次，第6～10天改為每天1次；10 d后予以常規(guī)治療，兩組患者均共治療30 d。分別于治療前及治療后檢測(cè)血管內(nèi)皮功能的指標(biāo)內(nèi)皮素-1（ET-1）、一氧化氮（NO）及炎癥因子白細(xì)胞介素-6（IL-6）、超敏C反應(yīng)蛋白（hs-CRP）水平。分別于治療前和治療后采用美國(guó)國(guó)立衛(wèi)生研究院卒中量表（NIHSS）進(jìn)行神經(jīng)功能缺損評(píng)估，按照美國(guó)介入和治療神經(jīng)放射學(xué)學(xué)會(huì)/介入放射學(xué)學(xué)會(huì)（ASITN/SIR）制定的側(cè)支血流分級(jí)標(biāo)準(zhǔn)評(píng)估患者治療后側(cè)支血流狀況。結(jié)果 治療前，兩組患者的炎癥因子（hs-CRP、IL-6）及血管內(nèi)皮功能指標(biāo)（NO、ET-1）指標(biāo)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。治療后，兩組NO水平均顯著升高（P＜0.05），ET-1水平均顯著降低（P＜0.05），對(duì)照組炎癥因子hs-CRP、IL-6水平較治療前無(wú)明顯改善（P＞0.05），試驗(yàn)組炎癥因子hs-CRP、IL-6水平均較治療前顯著降低（P＜0.05）；治療后試驗(yàn)組患者的炎癥因子（hs-CRP、IL-6）及血管內(nèi)皮功能指標(biāo)（NO、ET-1）指標(biāo)水平較對(duì)照組明顯改善（P＜0.05）；治療前兩組NIHSS評(píng)分比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05），經(jīng)過(guò)30 d的治療，試驗(yàn)組和對(duì)照組的NIHSS評(píng)分均顯著低于治療前（P＜0.05），且試驗(yàn)組患者的NIHSS評(píng)分較對(duì)照組顯著降低（P＜0.05）。治療30 d后，試驗(yàn)組患者側(cè)支血流代償情況較對(duì)照組改善明顯（P＜0.05）；治療過(guò)程中未發(fā)現(xiàn)阿加曲班的不良反應(yīng)。結(jié)論 急性缺血性腦卒中患者應(yīng)用阿加曲班治療后，炎癥反應(yīng)程度降低，血管內(nèi)皮功能的損傷減輕，阿加曲班在一定程度上可改善患者側(cè)支血流代償情況，進(jìn)一步改善神經(jīng)功能恢復(fù)，從而提升治療效果。

Objective To investigate the effects of argatroban on cerebral collateral blood flow, inflammatory factors, vascular endothelial function and prognosis in patients with acute ischemic stroke. Methods A total of 96 patients with acute ischemic stroke treated in Xuzhou Cancer Hospital from February 2018 to March 2020 were selected retrospectively. According to different treatment methods, the patients were divided into control group and experimental group, with 48 cases in each group. Patients in the control group were treated with routine treatment. The patients in the experimental group were treated with Argatroban Injection on the basis of routine treatment. On the first to second days, Argatroban Injection 60 mg + 0.9% Sodium Chloride Injection 500 mL, which was continuously pumped by the infusion pump for 24 h, On the 3rd to 5th days, 10 mg of Argatroban Injection was added to 100 mL of 0.9% Sodium Chloride Injection. The infusion pump completed the infusion within three hours, twice a day, and changed to once a day on the 6th to 10th days. Routine treatment was given after 10 days. Both groups were treated for 30 days. Endothelin-1 (ET-1), nitric oxide (NO), inflammatory factor interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) were measured before and after treatment. The neurological deficit was assessed with the National Institutes of Health Stroke Scale (NIHSS) before and after treatment, and the blood flow of the treated posterior branch was evaluated according to the collateral blood flow classification standard formulated by the American Society of interventional and Therapeutic Neuroradiology/Society of interventional radiology (ASITN/SIR). Results Before treatment, there was no significant difference in inflammatory factors (hsCRP, IL-6) and vascular endothelial function (NO, ET-1) between the two groups (P > 0.05). After treatment, the levels of inflammatory factors (hs-CRP, IL-6) and vascular endothelial function (NO, ET-1) in the experimental group were significantly improved compared with those in the control group (P < 0.05). After 30 d of treatment, the collateral blood flow compensation in the experimental group was better than that in the control group (P < 0.05), and the NIHSS score was significantly higher than that in the control group (P < 0.05). No adverse reactions of argatroban were found during the treatment. Conclusion After the treatment of acute ischemic stroke patients with argatroban, the degree of inflammatory reaction is reduced and the damage of vascular endothelial function is reduced. Argatroban can improve the collateral blood flow compensation of patients to a certain extent, further improve the recovery of neurological function, and improve the treatment effect.

R971