阿加曲班联合氯吡格雷治疗急性脑梗死合并下肢深静脉血栓的临床研究

目的 观察阿加曲班联合氯吡格雷治疗急性脑梗死合并下肢深静脉血栓的临床疗效。方法 选取2016年12月—2017年12月天津市中医药研究院附属医院收治的78例急性脑梗死合并下肢深静脉血栓患者，随机分为对照组和治疗组，每组各39例。两组均给口服硫酸氢氯吡格雷片，75 mg/次，1次/d。对照组腹壁皮下注射低分子量肝素钙注射液4 000 U/次，2次/d。治疗组前2 d持续静脉滴注阿加曲班注射液，60 mg以适当量输液稀释；后10 d静脉滴注阿加曲班注射液，20 mg以适当量输液稀释，3 h/次，2次/d。两组患者均治疗12 d。观察两组下肢静脉血栓疗效和脑梗死疗效，比较两组治疗前后双侧下肢周径差、D-二聚体、纤维蛋白原（FIB）、NIHSS评分的变化情况。结果 治疗后，对照组和治疗组下肢静脉血栓总有效率分别是74.35%、94.87%。两组比较差异具有统计学意义（P<0.05）；两组脑梗死总有效率分别是87.18%、92.31%，两组比较差异无统计学意义。治疗后，两组患者双侧下肢周径差、D-二聚体、FIB值、NIHSS评分均显著低于同组治疗前水平，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组双侧下肢周径差显著小于对照组，两组比较差异有统计学意义（P<0.05）。结论 阿加曲班联合氯吡格雷治疗急性脑梗死合并下肢深静脉血栓具有较好的临床疗效，可减少双侧下肢周径差，改善下肢静脉血栓症状，具有一定的临床应用推广价值。

Clinical study on argatroban combined with clopidogrel in treatment of acute cerebral infarction with deep venous thrombosis of lower limbs

Objective To observe the clinical efficacy of argatroban combined with clopidogrel in treatment of acute cerebral infarction with deep venous thrombosis of lower limbs. Methods 78 Patients with acute cerebral infarction with deep venous thrombosis of lower limbs in Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from December 2016 to December 2017 were randomly divided into control (39 cases) and treatment (39 cases) groups. Patients in two groups were po administered with Clopidogrel Hydrogen Sulphate Tablets, 75 mg/time, once daily. Patients in the control group were sc administered with Low Molecular Weight Heparin Calcium Injection, 4 000 U/time, twice daily. Patients in the treatmen group were iv administered with Argatroban Injection in the first two days of treatment, and 60 mg was diluted with appropriate infusion. The next 10 days were followed by intravenous infusion of Argatroban Injection, and 20 mg was diluted with appropriate infusion, 3 h/time, twice daily. Patients in two groups were treated for 12 d. After treatment, the clinical efficacy was evaluated, and the changes of serological indicators, seattle angina scale score and symptom score in two groups before and after treatment were compared. Results After treatment, the venous thrombosis efficacy in the control and treatment group were 74.35% and 94.87%, respectively, and there were differences between two groups (P<0.05). And cerebral infarction efficacy in two groups were 87.18% and 92.31%, respectively, and there was no difference between two groups. After treatment, the bilateral diameter difference, D-dimer, FIB and NIHSS score in two groups were significantly lower than those before treatment, and there were differences in the same group (P<0.05). After treatment, the bilateral diameter difference in the treatment group was lower than that in the control group, and there were differences between two groups (P<0.05). Conclusion Argatroban combined with clopidogrel has significant effect in treatment of acute cerebral infarction with deep venous thrombosis of lower limbs, and can reduce the bilateral diameter difference, and improve the symptoms of venous thrombosis in lower limbs, which has a certain clinical application value.