目的 探讨阿加曲班联合阿司匹林和氯吡格雷治疗急性进展性脑梗死的临床疗效。方法 选取2021年7月—2022年6月揭阳市人民医院神经内科诊治的急性进展性脑梗死患者80例，根据随机数字表法分成对照组和治疗组，每组各40例。对照组口服阿司匹林肠溶片100 mg/次，1次/d，口服硫硫酸氢氯吡格雷片，75 mg/次，1次/d。治疗组在对照组的基础上静脉滴注阿加曲班注射液，阿加曲班注射液60 mg加入生理盐水380 mL，输液泵维持24 h，用药2 d；第3～7天，阿加曲班注射液10 mg加入生理盐水250 mL输液泵维持3 h静脉滴注，每12小时1次。两组患者均治疗2周。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）、巴氏指数（BI）、血清炎症因子和凝血三项的变化情况。结果 治疗后，治疗组患者总有效率92.5%，显著高于对照组的72.5%（P＜0.05）。治疗后，两组患者NIHSS评分均较治疗前明显降低，BI指数均较治疗前明显升高（P＜0.05）；且治疗后，治疗组NIHSS评分低于对照组，BI指数显著高于对照组（P＜0.05）。治疗后，两组患者白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、超敏C反应蛋白（hs-CRP）水平较治疗前明显降低（P＜0.05），且治疗后治疗组IL-6、TNF-α、hs-CRP水平显著低于对照组（P＜0.05）。治疗前后同组患者凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）水平比较差异无统计学意义；治疗后，两组患者凝血三项指标比较差异无统计学意义。结论 阿加曲班联合阿司匹林和氯吡格雷双抗治疗急性进展性脑梗死具有较好的临床疗效，能减轻血管炎症反应，降低炎症反应，有较高的临床推广应用价值。

Objective To investigate the effect of argatroban combined with aspirin and clopidogrel in treatment of acute progressive cerebral infarction. Methods A total of 80 patients with acute progressive cerebral infarction diagnosed and treated in the Department of Neurology of Jieyang People’s Hospital from July 2021 to June 2022 were selected and divided into control group and treatment group according to random number table method, with 40 cases in each group. Patients in the control group were po administered with Aspirin Enteric Coated Tablets, 100 mg/time, once daily, Clopidogrel Hydrogen Sulphate Tablets 75 mg/time, once daily. Patients in the treatment group were iv administered with Agatuban Injection, adding 60 mg Agatuban Injection to 380 mL normal saline, maintained for 24 h with infusion pump, and treated for 2 d. On days 3 to 7, 10 mg of Agatuban Injection was added to 250 mL normal saline infusion pump for 3 h of intravenous infusion, once every 12 h. Both groups were treated for 2 weeks. The clinical efficacy of the two groups was observed, and the changes of the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), serum inflammatory factors and coagulation were compared between the two groups. Results After treatment, the total effective rate of the treatment group was 92.5%, which was significantly higher than that of the control group (72.5%, P < 0.05). After treatment, NIHSS score in 2 groups was significantly lower than before treatment, but BI index was significantly higher than before treatment (P < 0.05). After treatment, NIHSS score in the treatment group was lower than that in the control group, but BI index was significantly higher than that in the control group (P < 0.05). After treatment, the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and hypersensitive C-reactive protein (hs-CRP) in two groups were significantly decreased compared with before treatment (P < 0.05), and after treatment, the levels of IL-6, TNF-α, and hs-CRP in treatment group were significantly lower than those in control group (P < 0.05). There was no significant difference in the levels of thrombin time (TT), prothrombin time (PT) and activated partial prothrombin time (APTT) before and after treatment. After treatment, there was no significant difference in the three indexes of blood coagulation between the two groups. Conclusion Argatroban combined with aspirin and clopidogrel has good clinical efficacy in treatment of acute progressive cerebral infarction, and can reduce vascular inflammatory response and reduce inflammatory response, which has high clinical application value.

R971