阿加曲班序贯疗法联合rt-PA溶栓治疗急性缺血性脑卒中的疗效及对患者出血性转化的影响  

Clinical efficacy of Agattriban sequential therapy combined with rt-PA thrombolytic therapy in the treatment of acute ischemic stroke and its effect on hemorrhagic transformation

作　　者：余晓斐 张莉[2] 张亚恒 YU Xiao-fei;ZHANG Li;ZHANG Ya-heng(Department of Neurology,the Second Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,Henan,CHINA;Intensive Care Unit,Kaiyuan Hospital,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan,CHINA)

机构地区：[1]河南科技大学第二附属医院神经内科,河南洛阳471003 [2]河南科技大学第一附属医院开元院区重症医学科,河南洛阳471000

出　　处：《海南医学》2023年第17期2459-2463,共5页Hainan Medical Journal

基　　金：2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20200735)。

摘　　要：目的探讨阿加曲班序贯疗法联合rt-PA溶栓治疗急性缺血性脑卒中(AIS)的疗效及对患者出血性转化的影响。方法按随机数表法将2021年11月至2022年11月河南科技大学第二附属医院神经内科收治的98例AIS患者分为观察组和对照组各49例。两组均给予常规基础治疗,对照组患者采用rt-PA溶栓,观察组患者在对照组治疗的基础上予以阿加曲班序贯疗法治疗。比较两组患者的疗效及治疗前后的病情相关量表[改良Barthel指数(MBI)、美国国立卫生研究院卒中量表评分(NIHSS)、世界卫生组织生存质量测定量表(WHOQOL-100)]评分、凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、血清生化指标[白细胞介素-6(IL-6)、白细胞介素-2(IL-2)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平,同时比较治疗期间两组患者的不良事件发生情况。结果观察组患者的治疗总有效率为87.76%,明显高于对照组的65.31%,差异有统计学意义(P<0.05);治疗后,观察组患者的MBI、WHOQOL-100评分分别为(69.72±8.90)分、(91.22±3.02)分,明显高于对照组的(58.61±7.90)分、(79.31±3.46)分,NIHSS评分为(8.94±0.97)分,明显低于对照组的(11.20±1.87)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的PT、APTT、TT水平分别为(17.91±1.33)s、(34.68±1.91)s、(22.32±5.12)s,明显高于对照组(15.47±1.71)s、(32.60±1.81)s、(20.11±5.02)s,差异均有统计学意义(P<0.05);治疗后,观察组患者的IL-6、TNF-α、IL-2、CRP水平分别为(36.91±5.23)ng/L、(16.81±5.33)ng/L、(10.48±1.77)pg/mL、(9.21±1.16)mmol/L,明显低于对照组的(44.73±5.84)ng/L、(23.90±5.54)ng/L、(14.26±2.02)pg/mL、(11.08±2.01)mmol/L,差异均有统计学意义(P<0.05);观察组患者治疗期间的不良事件总发生率为12.24%,略低于对照组的18.37%,但差异无统计学意义(P>0.05)。结论阿加曲班序贯疗法联合rt-PA溶栓治疗AIS可有效减轻患者Objective To investigate the efficacy of Agattriban sequential therapy plus rt-PA thrombolytic therapy in the treatment of acute ischemic stroke(AIS)and its effect on hemorrhagic transformation.Methods Ninedoity-eight AIS patients admitted to the Department of Neurology,the Second Affiliated Hospital of Henan University of Science and Technology from November 2021 to November 2022 were divided into the observation group and the control group according to the method of random number table,each with 49 cases.Both groups were given conventional basic treatment.The patients in the control group were treated with rt-PA thrombolysis,while those in the observation group were treated with Argatroban sequential therapy on the basis of the treatment in the control group.The efficacy of the two groups was compared,as well as the scores of disease condition-related scales[Modified Barthel Index(MBI),National Institutes of Health Stroke Scale(NIHSS),and World Health Organization Quality of Life Scale(WHOQOL-100)],coagulation indices[prothrombin time(TT),prothrombinogen time(PT),activated partial thromboplastin time(APTT)],serum biochemical indices[interleukin-6(IL-6),interleukin-2(IL-2),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)],and the incidence of adverse events.Results The total effective rate of treatment in the observation group was 87.76%,which was significantly higher than 65.31%in the control group(P<0.05).After treatment,the MBI and WHOQOL-100 scores of the observation group were(69.72±8.90)points and(91.22±3.02)points,which were significantly higher than(58.61±7.90)points and(79.31±3.46)points of the control group;the NIHSS score was(8.94±0.97)points,which was significantly lower than(11.20±1.87)points in the control group;the differences were statistically significant(P<0.05).After treatment,the PT,APTT,and TT levels of the patients in the observation group were(17.91±1.33)s,(34.68±1.91)s,and(22.32±5.12)s,respectively,which were significantly longer than(15.47±1.71)s,(32.60±1.81)s,and(20.1

关 键 词：急性缺血性脑卒中 阿加曲班序贯疗法 RT-PA溶栓 神经功能 凝血功能 炎症反应 

分 类 号：R743.3[医药卫生—神经病学与精神病学]