急性脑梗死联合抗栓治疗的疗效分析

目的 评价急性脑梗死联合抗栓治疗的疗效。方法 收集2014年1月～2015年10月本院神经内科收治急性脑梗死病例227例,发病48 h内; 使用阿司匹林治疗的患者48例为阿司匹林组; 早期使用阿加曲班的患者72例为阿加曲班组; 早期联合使用阿加曲班和阿司匹林的患者107例为联合组; 3组均采用他汀类药物调脂、血压血糖控制等治疗; 阿加曲班注射液使用方法为首日和次日以60 mg剂量+生理盐水500 mL于24 h内滴完,自第3 d起用药剂量调整为10 mg+生理盐水250 mL分早晚2次滴注,每次于3 h内滴完,连续5 d; 使用NIHSS评分和mRS评分对两组患者在治疗前、疾病高峰时、14 d、6月进行评定,比较3组疗效。结果 阿司匹林组、阿加曲班组和联合组入院基线资料比较,性别构成、年龄、入院血压、入院血糖、LDL-C、入院初始NIHSS评分比较无显著差异(P>0.05),具有可比性。3组患者14 d时NIHSS评分较峰值NIHSS评分均有显著下降; 3组NIHSS评分改善度有显著差异,联合组显著大于其余2组,而阿司匹林组和阿加曲班组比较无明显差异(F=15.379,P<0.05); 3组患者病程6月时mRS比较联合组要显著低于阿司匹林组,其余组间比较无明显差异(F=2.376,P>0.05)。结论 急性脑梗死患者阿加曲班抗凝治疗有效,联合抗栓治疗显示具有更好的效果和预后。

The clinical study on the efficacy of combined antithrombotic therapy of acute cerebral infarction

ObjectiveTo evaluate the efficacy of combined antithrombotic therapy of acute cerebral infarction.Methods 227 patients with acute cerebral infarction were collected within 48 hours after onset from January 2014 to October 2015, the patients were divided into the aspirin group(the aspirin therapy,48 cases), the argatroban group(the argatroban therapy, 72 cases), the combined antithrombotic group(the argatroban and aspirin therapy, 107 cases). Three groups were treated by the basic therapy such as stains lipid lowing, blood pressure and blood sugar controlling.the argatroban group and combined antithrombotic group were treated with venous argatroban in 1^st week. It was 60 mg/d within the first 2 days and 24 h continuous drip.From the beginning of the 3^rd day, the dosage was changed to 10 mg each time, twice a day for 5 days.The degree of neurological deficit was compared by the National Institutes of Health Stroke Scale(NIHSS)Scoring and the rehabilitation condition was evaluated by modified Rankin Scale(mRS)scoring among 3 groups before treatment, at the peak time of disease course and 14 d, 6 months after treatment respectively.Results There was no significant difference in sex composition, age, blood pressure, blood glucose, LDL-C, admission NIHSS score among three groups. 14d NIHSS score of each group was significantly lower than that at the peak time of disease course. There were significant differences at the degree of improvement in NIHSS scores among the three groups. NIHSS score improvement was significantly higher in the combined antithrombotic group than those in the other two groups, while there was no difference between the aspirin group and the argatroban group(F=15.379, P<0.05). mRS score was significantly lower in the combined antithrombotic group 6 months after treatment than that in the aspirin group, while there was no difference among the other groups(F=2.376, P>0.05).Conclusion Argatroban anticoagulant treatment is effective on the patients with acute cerebral infarction within 48 hours after onset.The combined antithrombotic treatment showed better effect and prognosis.