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目的：观察阿替普酶静脉溶栓联合阿加曲班序贯治疗急性脑梗死患者的有效性与安全性。方法：将90例符合标准的急性脑梗死患者，按随机数字表法分为3组，每组30例，均给予调控血压、调脂稳定斑块、神经保护等常规支持治疗。对照组用阿替普酶静脉溶栓治疗，高、低剂量试验组分别在阿替普酶静脉溶栓治疗后给予高、低剂量阿加曲班序贯治疗，溶栓治疗24 h后复查头颅CT，统计脑出血情况。对治疗前、治疗3个月后各组患者美国国立卫生研究院卒中量表（National institute of health stroke scale,NIHSS）评分和Barthe指数（Barthel index,BI）评分进行比较，同时监测记录各组患者并发症与病死率等，对比3组患者神经功能改善程度以及日常生活活动能力。结果：3组患者治疗前NIHSS评分、BI评分、改良Rankin量表（Modified rankin scale,mRS）评分和mRS≤2分患者数相近，差异无统计学意义（P>0.05）。治疗后3个月NIHSS评分下降，治疗前后组内比较，对照组差异无统计学意义（P>0.05），高、低剂量试验组差异有统计学意义（P<0.01）；组间比较高、低剂量试验组较对照组下降趋势更大，但高、低剂量试验组差异无统计学意义（P>0.05）。mRS评分下降、BI评分和良好功能结局患者数增加，高、低剂量试验组明显优于对照组，组间及组内治疗前后比较差异有统计学意义（P<0.05）。总并发症发生率及死亡率3组比较，差异无统计学意义（P>0.05）。结论：阿替普酶静脉溶栓后2种剂量阿加曲班序贯治疗急性脑梗死较单纯使用阿替普酶静脉溶栓的临床疗效好，不同剂量阿加曲班序贯治疗疗效相同，且并未增加出血风险，值得临床推广。
Abstract：Objective : To evaluate the efficacy and safety of intravenous thrombolysis with Alteplase combined with Sequential Argatroban therapy for acute cerebral infarction(ACI). Methods : A total of 90 eligible patients with ACI were randomly divided into three groups using a random number table,( 30 patients each) using a random number table method. All patients received conventional supportive treatments, including blood pressure regulation, lipid-lowering and plaquestabilizing therapy, and neuroprotection. In addition, Group A was treated with intravenous thrombolysis using alteplase, while Groups B and C received sequential therapy with high-dose and low-dose argatroban, respectively, after alteplase intravenous thrombolysis. Head CT scans were repeated 24 hours after thrombolytic therapy to assess cerebral hemorrhage. National Institute of Health Stroke Scale(NIHSS) scores and Barthel Index(BI) scores were evaluated before treatment and at 3 months post-treatment. Complications and mortality rates were also observed in all groups. The degree of neurological function improvement and activities of daily living capabilities were compared among the three groups. Results : Prior to treatment, no significant statistical difference was observed in NIHSS scores, BI scores, modified Rankin Scale(mRS) scores, or the number of patients with mRS ≤ 2 among the three groups(P>0. 05). After 3 months, NIHSS scores decreased in all groups. There was no significant difference in Group A when comparing pre-and post-treatment scores(P>0. 05), while significant differences were observed in both the high-dose and low-dose experimental groups(P<0. 01). Although the high-dose and low-dose experimental groups showed a greater downward trend in NIHSS scores compared to the control group, the differences were not statistically significant(P>0. 05). mRS scores decreased, while BI scores and the number of patients with good functional outcomes increased in the high-dose and low-dose experimental groups, which were significantly better than the control group, with statistically significant differences both within and between groups(P<0. 05). There were no significant differences in total complications and mortality rates among the three groups(P>0. 05). Conclusion : Sequential therapy with either dose of argatroban after alteplase intravenous thrombolysis for ACI yields better clinical outcomes compared to alteplase intravenous thrombolysis alone. The efficacy of two different doses of argatroban in sequential therapy is similar, it does not increase the risk of hemorrhage, making it worthy of clinical promotion.
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基本信息:
中图分类号:R743.33
引用信息:
[1]肖开敏,陈红梅,刘孚强,等.阿替普酶静脉溶栓联合阿加曲班序贯治疗急性脑梗死患者的有效性与安全性研究[J].赣南医科大学学报,2025,45(11):1050-1055.
基金信息:
江西省卫生健康委员会科技计划项目(编号:20212371)