[关键词]
[摘要]
目的 观察阿加曲班联合阿替普酶治疗急性脑卒中的疗效及其对氧化应激和炎症因子的影响。方法 回顾性选取2018年6月—2020年12月徐州医科大学附属连云港东方医院收治的急性脑卒中患者84例,发病均在4.5 h内,根据治疗方法将患者分为对照组(n=42)和观察组(n=42)。对照组给予注射用阿替普酶(0.9 mg/kg为其标准剂量,最大使用剂量不超过90 mg)静脉溶栓及常规治疗,观察组在对照组的基础上静脉溶栓24 h后加用阿加曲班注射液治疗,第1~2天,阿加曲班注射液60 mg静脉滴注24 h;第3~7天,阿加曲班注射液10 mg静脉滴注3 h,2次/d,两组患者治疗疗程均为14 d。分别于治疗前和治疗14 d后采用美国国立卫生研究院卒中量表(NIHSS)和改良Barthel指数量表(MBI)对两组患者神经功能缺损和日常生活能力进行评分,检测两组患者的氧化应激标志物超氧化物歧化酶(SOD)和丙二醛(MDA)水平,检测血清炎症标志物白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,监测出血性转化(HT)发生率及药物的不良反应。结果 治疗14 d后,观察组的总有效率高于对照组(P<0.05);两组患者的NIHSS评分及血清MDA、IL-6及TNF-α水平均较治疗前明显下降(P<0.01),MBI评分及SOD水平较治疗前明显升高(P<0.01),且观察组相比对照组改善作用更加明显(P<0.01)。两组患者治疗14 d内,HT发生率及不良反应发生率比较差异均无统计学意义。结论 阿加曲班注射液具有抗炎、抑制氧化应激作用,联合阿替普酶治疗急性脑卒中安全有效,与单独阿替普酶静脉溶栓治疗相比,可显著改善预后,且未增加HT风险及不良反应发生率。
[Key word]
[Abstract]
Objective To observe the efficacy of argatroban combined with alteplase in the treatment of acute stroke and its effects on oxidative stress and inflammatory factors. Methods Totally 84 patients with acute stroke treated in Lianyungang Oriental Hospital Affiliated to Xuzhou Medical University from June 2018 to December 2020 were selected retrospectively. All of them were within 4.5 h. According to the treatment methods, the patients were divided into control group (n=42) and observation group (n=42). Patients in the control group were given intravenous thrombolysis and routine treatment with alteplase for injection (0.9 mg/kg as the standard dose, and the maximum dose was no more than 90 mg). Patients in the observation group were treated with Argatroban Injection after intravenous thrombolysis for 24 h on the basis of the control group. On the first to second days, 60 mg Argatroban Injection was injected intravenously for 24 h, on the 3rd-7th day, Argatroban Injection 10 mg was injected intravenously for three hours, twice a day. The treatment course of both groups was 14 days. The neurological deficits and activities of daily living of the two groups were scored by National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (MBI) before and 14 days after treatment. The levels of oxidative stress markers superoxide dismutase (SOD) and malondialdehyde (MDA) and serum inflammatory markers interleukin-6 (IL-6) were detected And tumor necrosis factor-α (TNF- α). Results After 14 days of treatment, the total effective rate of the observation group was higher than that of the control group (P<0.05), the NIHSS score, serum MDA, IL-6 and TNF-a levels of the two groups were significantly lower than those before treatment (P<0.01), and the MBI score and SOD level were significantly higher than those before treatment (P<0.01). There was no significant difference in the incidence of HT and adverse reactions between the two groups within 14 d of treatment. Conclusion Argatroban Injection has antiinflammatory and anti-oxidative stress effects. It is safe and effective in the treatment of acute stroke combined with alteplase. Compared with intravenous thrombolysis with alteplase alone, it can significantly improve the prognosis without increasing the risk of HT and the incidence of adverse reactions.
[中图分类号]
R971
[基金项目]