目的 观察阿替普酶静脉溶栓后再闭塞的脑卒中患者应用阿加曲班治疗的临床疗效。方法 回顾性选择2020年5月—2021年5月诸暨市人民医院经CT扫描确诊的因大脑中动脉及分支狭窄或闭塞引发的早期急性脑卒中且经阿替普酶静脉溶栓后发生再闭塞的患者47例为研究对象，根据治疗方法将患者分为对照组（n=24）和试验组（n=23），两组患者均用注射用阿替普酶溶栓治疗（0.9 mg/kg），l min内静脉注射总剂量的10%，剩余药液于1 h内静脉滴注完毕。对照组在阿替普酶溶栓治疗24 h后静脉滴注300 mL 0.9%氯化钠溶液，每日1次；第3～7天改为静脉滴注100 mL 0.9%氯化钠溶液，每日1次。试验组给予阿加曲班注射液10 mg加入至30 mL 0.9%氯化钠溶液中，12.5 mL/h微泵静推维持48 h，溶栓治疗后的第3～7天阿加曲班注射液改为每日2次微泵静推（每次用阿加曲班注射液10 mg加入至30 mL 0.9%氯化钠溶液中，12.5 mL/h微泵静推维持4 h）。两组均在溶栓24 h后头颅CT排除脑出血后常规给予脑卒中二级预防药物。比较两组临床疗效，分别采用美国国立卫生研究院卒中量表（NIHSS）及日常生活能力量表（ADL）评估治疗前后及治疗后1个月两组患者神经功能缺损及日常生活活动能力。结果 试验组总有效率95.7%显著高于对照组的66.7%（P<0.05）；在治疗后和治疗后1个月，试验组NIHSS评分、ADL评分与治疗前比较，差异均有统计学意义（P<0.05）；试验组治疗后的NIHSS评分明显低于对照组（P<0.05），ADL评分明显高于对照组（P<0.05）。结论 阿加曲班可改善阿替普酶静脉溶栓后再闭塞脑卒中患者的神经功能，疗效较好，改善患者日常生活质量，改善预后。

Objective To observe the clinical efficacy of argatroban in patients with stroke after intravenous thrombolysis with alteplase. Methods 47 patients with early acute cerebral infarction caused by stenosis or occlusion of middle cerebral artery and branches diagnosed by CT scan in Zhuji people's Hospital from May 2020 to May 2021 and reocclusion after intravenous thrombolysis with alteplase were selected as the research objects. According to the treatment method, the patients were divided into control group (n=24) and experimental group (n=23). Patients in both groups were treated with thrombolysis with alteplase for injection (0.9 mg/kg), 10% of the total dose was injected intravenously within 1 min, and the remaining solution was injected intravenously within 1 h. Patients in the control group were given 300 mL of 0.9% sodium chloride solution by intravenous drip once a day 24 hours after thrombolytic treatment with alteplase, and 100 mL of 0.9% sodium chloride solution were given by intravenous drip once a day on the 3rd to 7th days. Patients in the experimental group were given 10 mg of Argatroban Injection and added to 30 mL of 0.9% sodium chloride solution. The 12.5 mL/h micropump was pushed for 48 h. On the 3rd to 7th days after thrombolytic treatment with alteplase, Argatroban Injection were changed to micropump twice a day (Add 10 mg of Argatroban Injection to 30 mL of 0.9% sodium chloride solution each time, and push it with a micro pump at 12.5 mL/h for four hours). Patients in both groups were given secondary preventive drugs for cerebral infarction 24 h after thrombolysis. The clinical effects of the two groups were compared. The neurological deficit and activities of daily living of the two groups were evaluated by National Institutes of Health Stroke Scale (NIHSS) and activity of daily living scale (ADL) before treatment, after treatment and 1 month after treatment. Results the total effective rate of 95.7% in the experimental group was significantly higher than 66.7% in the control group (P<0.05). After treatment and one month after treatment, the NIHSS score and ADL score in the experimental group were significantly different from those before treatment (P<0.05). After treatment, the NIHSS score of the experimental group was significantly lower than that of the control group (P<0.05), and the ADL score was significantly higher than that of the control group (P<0.05). Conclusion Argatroban can improve the neurological function, improve the quality of daily life and prognosis of patients with cerebral infarction after intravenous thrombolysis with alteplase.

R971

诸暨市医药卫生科技项目（2020YW033）