目的 观察阿加曲班联合阿司匹林治疗穿支动脉病变型进展性脑梗死的临床疗效。方法 选取2018年1月-2020年12月天津市中医药研究院附属医院针灸病房收治的120例穿支动脉病变型进展性脑梗死患者,根据随机数字表法将患者分为对照组和治疗组,每组各60例,剔除脱落病例(n=9)后剩余对照组56例,治疗组55例。对照组口服阿司匹林肠溶片,100 mg/次,1次/d。治疗组在对照组治疗基础上静脉滴注阿加曲班注射液,60 mg/d适当输液稀释,持续静脉滴注48h;后减量至20mg/d,2次/d,静脉滴注12 d。两组均治疗14 d。观察两组的临床疗效,比较两组美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数、血浆脂蛋白磷脂酶A₂(LP-PLA₂)、D-二聚体(D-dimer)和活化部分凝血活酶时间(APTT)。结果 治疗后,治疗组总有效率是81.82%,显著高于对照组的62.50%(P<0.05)。治疗后,两组NIHSS评分显著下降,Barthel指数较显著升高(P<0.05),其中治疗组NIHSS评分显著低于对照组,Barthel指数显著高于对照组,两组间比较差异有统计学意义(P<0.05)。治疗后,两组LP-PLA₂、D-dimer显著降低,APTT显著延长(P<0.05),其中治疗组治疗后LP-PLA₂、D-dimer显著低于对照组,APTT显著长于对照组(P<0.05)。结论 阿加曲班联合阿司匹林治疗穿支动脉病变型进展性脑梗死具有良好的疗效,可改善患者的神经功能和血液高凝状态,提高患者的生活能力,且安全性高。

Objective To observe the clinical efficacy of argatroban combined with aspirin in treatment of progressive cerebral infarction caused by perforator artery lesions. Methods A total of 120 patients with progressive cerebral infarction with perforating artery lesions treated in the acupuncture ward of Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from January 2018 to December 2020 were selected. According to the random number table method, the patients were divided into control group and treatment group, with 60 cases in each group. After removing the detached cases (n=9), there were 56 cases in the control group and 55 cases in the treatment group. Patients in the control group were po administered with Aspirin Enteric-coated Tablets, 100 mg/time, once daily. Patients in the treatment group were iv administered with Argatroban Injection on the basis of the control group, 60 mg/d was diluted with appropriate infusion and continued intravenous infusion for 48 h. Then the dosage was reduced to 20 mg/d, twice daily, and intravenous infusion was given for 12 d. Both groups were treated for 14 d. The clinical efficacy of the two groups were observed, and the scores of national Institutes of Health Stroke Scale (NIHSS), Barthel index, plasma lipoprotein phospholipase A₂ (LP-PLA₂), D-dimer and activated partial thrombin time (APTT) were compared between the two groups. Results After treatment, the total effective rate of treatment group was 81.82%, significantly higher than that of control group 62.50% (P < 0.05). After treatment, NIHSS score was significantly decreased, but Barthel index was significantly increased in both groups (P < 0.05). NIHSS score in the treatment group was significantly lower than that in the control group, but Barthel index was significantly higher than that in the control group, with statistically significant differences between the two groups (P < 0.05). After treatment, LP-PLA₂ and D-Dimer in the two groups were significantly decreased, while APTT was significantly increased (P < 0.05). LP-PLA₂ and D-Dimer in the treatment group were significantly lower than those in the control group, but APTT was significantly higher than those in the control group (P < 0.05). Conclusion Agaltreban combined with aspirin has good efficacy in treatment of progressive cerebral infarction with perforator artery lesions, and can improve patients' neurological function and blood hypercoagulability, and improve their living ability with high safety.

R971