阿加曲班联合尤瑞克林对急性进展性脑卒中患者NIHSS评分和ADL评分的影响

目的 观察阿加曲班联合尤瑞克林治疗急性进展性脑卒中的疗效及安全性。方法 回顾性选取2019年1月—2021年6月揭阳市人民医院神经内科诊治的急性进展性脑卒中患者80例，根据治疗方法分成对照组和观察组，每组各40例。两组患者均严格依照急性缺血性脑血管病指南，予以规范诊治，对照组应用注射用尤瑞克林0.15 PNA单位加入至0.9%氯化钠注射液100 mL中静脉滴注，1次/d，静脉滴注给药时间不少于50 min，用药期间密切监测血压变化情况，疗程为14 d。观察组在应用注射用尤瑞克林的同时，加用阿加曲班注射液，在开始治疗的第1～2天，阿加曲班注射液60 mg加入至0.9%氯化钠注射液380 mL中，输液泵泵入，24 h持续不间断静脉输注，从第3天起，阿加曲班注射液10 mg加入至0.9%氯化钠注射液250 mL中，输液泵泵入，持续3 h静脉输注，12 h/次，用药5 d，疗程为7 d。分别于治疗前、治疗后采用美国国立卫生研究院卒中量表（NIHSS）评估患者的神经缺损程度，采用日常生活活动功能量表（ADL）评估两组患者生活自理能力。同时监测血细胞、肝肾功能等生化指标及凝血指标的动态变化，观察治疗过程中出现的不良反应情况。结果 治疗后，观察组的总有效率为92.5%，显著高于对照组的72.5%，治疗后对照组和观察组NIHSS评分均较治疗前显著降低（P<0.05），ADL评分显著升高（P<0.05）；治疗后观察组NIHSS评分显著低于对照组（P<0.05），ADL评分显著高于对照组（P<0.05）。两组患者的不良反应发生率低，未出现严重不良反应。结论 急性进展性脑卒中患者采用阿加曲班注射液联合尤瑞克林的治疗方案，病情得到有效控制，病残率较低，日常独立生活能力提高，且安全性好，有较高的临床推广应用价值。

Effect of argatroban combined with urecolin on NIHSS score and ADL score in patients with acute progressive stroke

Objective To observe the efficacy and safety of argatroban combined with urecolin in the treatment of acute progressive stroke. Methods 80 patients with acute progressive stroke treated in the Department of Neurology of Jieyang People''s Hospital from January 2019 to June 2021 were selected retrospectively. According to the treatment methods, patients were divided into control group and observation group, with 40 cases in each group. The patients in both groups were treated in strict accordance with the guidelines for acute ischemic cerebrovascular disease. Patients in the control group were injected with 0.15 PNA unit of urinary kallikrein for injection into 100 mL of 0.9% sodium chloride injection, once a day, for no less than 50 min. The changes of blood pressure were closely monitored during the medication period, and the course of treatment was 14 days. Patients in the observation group were added with Argatroban Injection while using urinary kallidinogenase for injection. On the first to second days of treatment, 60 mg of Argatroban Injection was added to 380 mL of 0.9% sodium chloride injection, pumped by infusion pump, and continued intravenous infusion for 24 h. From the third day, 10 mg of Argatroban Injection was added to 250 mL of 0.9% sodium chloride injection, pumped by infusion pump, continuous intravenous infusion for three hours, 12 h/time, five day, and the course of treatment was seven days. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of nerve defect before and after treatment, and activity of daily living (ADL) scale was used to evaluate the self-care ability of the two groups. At the same time, the dynamic changes of biochemical indexes such as blood cells, liver and kidney function and coagulation indexes were monitored, and the adverse reactions during treatment were observed. Results After treatment, the total effective rate of the observation group was 92.5%, significantly higher than 72.5% of the control group. After treatment, the NIHSS scores of the control group and the observation group were significantly lower than those before treatment (P<0.05), and the ADL scores were significantly higher (P<0.05). After treatment, the NIHSS score of the observation group was significantly lower than that of the control group (P<0.05), and the ADL score of the observation group was significantly higher than that of the control group (P<0.05). The incidence of adverse reactions in the two groups was low, and there were no serious adverse reactions. Conclusion The treatment of acute progressive stroke patients with Argatroban Injection combined with urecolin can effectively control the condition, reduce the disability rate, improve the ability of daily independent living, and have good safety. It has high clinical application value.