阿加曲班联合阿司匹林治疗急性后循环脑梗死的临床效果和安全性评估  

Effect and safety of combined treatment with argatroban and aspirin in acute posterior circulation cerebral infarction

作　　者：付建忠[1] 黄开梅[1] 王锋[1] 沈蓉[1] 

机构地区：[1]南京医科大学附属苏州医院神经内科,江苏苏州215001

出　　处：《中国医学前沿杂志（电子版）》2016年第12期89-93,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的评估阿加曲班联合阿司匹林治疗急性后循环脑梗死的临床效果和安全性。方法选取2013年1月至2015年12月于本院住院治疗的急性后循环脑梗死患者92例为研究对象。采用抽签法将入选患者随机分为单抗组(阿司匹林治疗)、双抗组(阿司匹林+氯吡格雷治疗)和观察组(阿加曲班+阿司匹林治疗),所有患者治疗7天后均改为单用阿司匹林治疗。分别于入院时(起病48小时内)、治疗1周及1个月后,采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)和巴氏指数(Barthel index,BI)评分评估三组患者的神经功能和生活能力,并于入院时和治疗1周后检测三组患者血小板(blood platelet,PLT)、活化部分凝血活酶时间(activated partialthromboplastin time,APTT)、凝血酶原国际标准化比值(international normalized ratio,INR)。结果入院时三组患者NIHSS评分和BI评分比较差异均无显著性(P>0.05)。治疗1周后,观察组患者NIHSS评分低于单抗组和双抗组(P=0.014,P=0.039),BI评分高于单抗组(P=0.020),与双抗组比较无显著差异(P>0.05)。治疗1个月后,双抗组和观察组患者NIHSS评分均低于单抗组(P=0.010,P<0.001),观察组患者NIHSS评分低于双抗组(P=0.031);双抗组和观察组患者BI评分均显著高于单抗组(P=0.025,P=0.017),观察组患者BI评分高于双抗组(P=0.046)。治疗1周内,单抗组患者均未发生出血事件;双抗组和观察组各有1例患者发生出血事件,但两组患者出血事件发生率比较差异无显著性(χ~2=0.001,P=0.999)。入院时和治疗1周后,三组患者PLT、APTT及INR比较差异均无显著性(F=1.416,P=0.248)。结论阿加曲班联合阿司匹林治疗急性后循环脑梗死的效果优于单用阿司匹林和阿司匹林联合氯吡格雷,且安全性较好。Objective To evaluate the effects and safety of combined treatment with argatroban and aspirin in acute posterior circulation cerebral infarction. Method 92 patients with posterior circulation cerebral infarction treated in our hospital from January 2013 to December 2015 were selected as the subjects, they were randomly divided into three groups, including simple anti-platelet group, combined anti-platelet group and observed group by sortition, which were respectively given aspirin, aspirin and clopidogrel, argatroban and asprin. After 7 days, all patients changed to use aspirin simply. National Institutes of Health Stroke Scale （NIHSS） and Barthel index （BI） were taken to evaluate the neurological function and living ability at admission （48 hours after disease onset）, 1 week and 1 month after treatment. Blood platelet （PLT）, activated partialthromboplastin time （APTT） and international normalized ratio （INR） were examined at admission and 1 week after treatment. Result There were no significant differences in NIHSS scores and BI scores at admission among the three groups （P 〉 0.05）. 1 week after treatment, the NIHSS score of observation group was significantly lower than simple anti-platelet group and combined anti-platelet group （P = 0.014, P=0.039）; the BI score of observation group was significantly higher than simple anti-platelet group （P ^- 0.020）, and there was no significant difference in BI score between observation group and combined anti-platelet group （P ~ 0.05）. 1 month after treatment, the NIHSS score of observation group and combined anti-platelet group were lower than simple anti-platelet group （P ---- 0.010, P ~ 0.001）, the NIHSS score of observation group was lower than combined anti-platelet group （P ~ 0.031）. The BI score of observation group and combined anti-platelet group were significantly higher than simple anti-platelet group （P = 0.025, P=0.017）, and the BI score of observation group was higher than combined anti-platelet group （

关 键 词：急性后循环脑梗死 阿加曲班 阿司匹林 神经功能恢复 安全性 

分 类 号：R743.33[医药卫生—神经病学与精神病学]