目的 探討阿加曲班聯合阿司匹林在早期進展性缺血性腦卒中治療中的應用效果。方法 納入2019年1月—2022年1月火箭軍特色醫(yī)學中心收治的發(fā)病24 h內、未接受靜脈溶栓治療和血管內介入治療的急性進展性缺血性腦卒中患者120例為對象進行回顧性研究。根據治療方案的不同分為對照組（阿司匹林聯合氫硫酸氯吡格雷）及試驗組（阿加曲班聯合阿司匹林），每組各60例。對照組口服阿司匹林腸溶片每次100 mg，每天1次，同時聯合口服硫酸氫氯吡格雷片每次75 mg，每天1次，共3周。試驗組予以阿司匹林腸溶片，用法用量同對照組，在此基礎上聯合阿加曲班注射液，治療前48 h給予阿加曲班注射液60 mg，每天1次，24 h持續(xù)靜脈泵入，第3～7天予以阿加曲班注射液每次10 mg，每天2次，3 h靜脈滴注。兩組住院治療時間均≥14 d。分別采用美國國立衛(wèi)生研究院卒中量表（NIHSS）評分及根據Barthel指數（BI）評分比較治療前后兩組患者神經功能缺損情況及日常生活能力改善情況，并觀察兩組的癥狀性腦出血及消化道出血等不良反應情況。結果 試驗組與對照組治療的總有效率分別為82.67%和65.00%，差異有統計學意義（P＜0.05）。治療前兩組NIHSS比較，差異有統計學意義（P＜0.05）。治療后兩組患者NIHSS評分均較治療前顯著降低（P＜0.05），試驗組降低程度更加明顯，治療后兩組 NIHSS評分比較，差異無統計學意義（P＞0.05）。治療前，試驗組 BI評分低于對照組，但差異無統計學意義（P＞0.05）；治療后，兩組患者BI評分均較同組治療前顯著增加（P＜0.05），且試驗組BI評分顯著高于對照組（P＜0.05）。治療期間出現消化道出血的患者對照組有3例，試驗組有2例；兩組患者均無癥狀性腦出血出現。兩組間主要不良反應比較，差異無統計學意義（P＞0.05）。結論 阿加曲班聯合阿司匹林較常規(guī)雙抗治療更有助于改善早期急性進展性缺血性腦卒中患者的神經功能預后，同時不增加不良反應風險。

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.

R971