吴年宝;

• 1:泰州市中医院

摘要(Abstract)：

目的观察阿加曲班联合阿司匹林+氯吡格雷治疗72h内脑梗死的疗效及安全性评估。方法 2018-07—2019-10泰州市中医院收治72h内急性脑梗死患者80例,随机分为2组,研究组40例,常规组40例。常规组予阿司匹林联合氯吡格雷抗血小板聚集,同时予清除氧自由基、调控血压、血糖控制、改善脑代谢等治疗。研究组在常规组的基础上加用阿加曲班注射液,首日和次日以60mg剂量于24h内持续静脉泵入,自第3天起,剂量调整为10mg 2次/d,每次于3h内静脉泵入,持续使用5d;比较治疗前、治疗7d、14d后凝血功能(PT、TT、APTT、FIB)和血小板(PLT)计算变化,比较治疗前、治疗后7d、14dNIHSS评分、Barthel生活指数、临床疗效。结果研究组患者治疗前凝血功能与治疗7d、14d后差异无统计学意义(P>0.05),虽血小板计数2组均降低,但差异无统计学意义(P>0.05)。研究组与常规组患者治疗前NIHSS评分和Barthel指标数,2组差异无统计学意义(P>0.05),治疗7d、14d后2组评分均有明显升高(P<0.05),但研究组NIHSS评分和Barthel指标均好于常规组,差异有统计学意义(P<0.05)。研究组治疗后总有效率82.5%,明显高于对照组65.0%(P<0.05),且出血风险无明显增加。结论阿加曲班应用于急性脑梗死的临床治疗具有较好的疗效和安全性。

关键词(KeyWords)： 脑梗死;阿加曲班;双抗;阿司匹林;氯吡格雷

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 吴年宝;

参考文献(References)：

• [1] SONG T J,CHANGY,CHUN M Y,et al.High Dietary Gly-cemic Load is Associated with Poor Functional Outcome in Patients with Acute Cerebral Infarction[J].J Clin Neurol,2018,14(2):165-173.
• [2] CHEN L,CAO S,YANG J.Argatroban plus aspirin versus aspirin in acute ischemic stroke[J].Neurol Res,2018,40(10):862-867.
• [3] WANG Y,LIAO X,ZHAO X,et al.Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China:analysis of the results from the Chinese National Stroke Registry(CNSR)[J].Stroke,2011,42(6):1658-1664.
• [4] GEE J M,KALIL A,THULLBERY M,et al.Induction of immunologic tolerance to myelin basic protein prevents central nervous system autoimmunity and improves outcome after stroke[J].Stroke,2008,39(5):1575-1582.
• [5] LIN Z J,QIU H Y,TONG X X,et al.Evaluation of efficacy and safety of Reteplase and Alteplase in the treatment of hyper-acute cerebal infarction[J].Biosci Rep,2018,38(1):BSR20170370.
• [6] HE X,LI DR,CUI C,et al.Clinical significance of serum MCP-1and VE-cadherin levels in Patients with acute cerebral infarction[J].Eur Rev Med Pharmaco,2017,21(4):804.
• [7] ESTEVE-PASTOR M A,HERNANDEZ-ROMERO D,VALD S M,et al.New approaches to the role of thrombin in acute coronary syn-dromes:quo vadis bivalirudin,a direct thrombin Inhibitor[J].Molecules,2016,21(3):284.
• [8] HIROAKI O,MITAKI S,HIROYUKI T,et al.Retrospective Analysis of Argatroban in 353Patients withAcute Noncardioembolic Stroke[J].J Stroke Cereb Dis,2018,27(8):2175-2181.
• [9] JING R,CUI M,WANG H,et al.Evaluation of Argatroban as a Potential Anticoagulant for ClinicalLaboratoryAnalysis:Precision,StabilityandInterference Study[J].Clinical Laboratory,2016,62(4):621.
• [10] WADA T,YASUNAGA H,HORIGUCHI H,et al.Outcomes of argatroban treatment in patients with atherothrombotic stroke:observational nationwide stud in Jaypan[J].Stroke,2016,25:2828-2837.
• [11] HOLINSTAT M,COLOWICK N E,HUDSON W J,et al.Dichotomous effects of exposure to bivalirudin in patients undergoing percutaneous coronary intervention on protease-activated receptor-mediated platelet activation[J].J Thrombosis,2013,35(2):209-222.
• [12]徐向东,黄贞,邢秋芳,等.阿加曲班治疗急性脑梗死患者的疗效及对血清和肽素N末端脑钠肽前体的影响[J].中国实用神经疾病杂志,2017,20(7):113-115.
• [13]孙福海.阿加曲班联合依达拉奉对急性脑梗死患者血清和肽素N末端脑纳肽前体的影响[J].中国实用神经疾病杂志,2017,20(2):109-111.
• [14] AVERILL M M,KERKHOFF C,BORNFELDT K E.S100A8and S100A9in cardiovascular biology and disease[J].Arterioscler Thromb Vasc Biol,2012,32(2):223-229.
• [15] ADEOYE O,KNIGHT W A,KHOURY J,et al.A matched compari-son of eptifibatide plus rt-PA versus rt-PA alone in acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2014,23(4):e313-e315.
• [16]张亮,程立,刘桂花.阿加曲班治疗急性脑梗死对患者血管内皮功能Hcy及炎症状态的影响[J].中国实用神经疾病杂志,2017,20(8):17-19.
• [17] JIANG Y,LIAN Y J.Effect of Danhong injection on hemodynamics and the inflammation-relted NF-kB signaling pathway in patients wth acute cerebral infarction[J].Genet Mol Res,2015,14(4):16929-16937.
• [18] VANGILDER R L,DAVIDOV D M,STINEHART K R,et al.C-reac-tive protein and long-term ischemic stroke prognosis[J].J Clin Neurosci,2014,21(4):547-553.
• [19] ZANG R S,ZHANG H,XU Y,et al.Serum C-reactive protein,fibrinogen and D-dimer in patients with progressive cerebral infarction[J].Translational Neuroscience,2016,7(1):84-88.
• [20] GOSSELIN R,GRANT R P,ADCOCK D M.Comparison of the effect of the anti-Xa direct oral anticoagulants apixaban,edox-aban,and rivaroxaban on coagulation assays[J].Int J Lab Hematol,2016,38(5):505-513.
• [21] GUVVALA V,CHIDAMBARAM SUBRAMANIAN V,ANIREDDY J S,et al.Novel degradation Products of aegatroban:Isolation,synthesis and extensive characterization using NMR and LC-PDA-MS/Q-TOF[J].J Pharm Anal,2018,8(2):86-95.
• [22] ENGSTROM M,RUNDGREN M,SCHOTT U.An evaluation ofmonitoring possibilities of argatroban using rotational thromboelastometry and activated partial thromboplastin time[J].Acta Anaesthesiol Scand,2010,54(1):86-91.
• [23] LEE C J,ANSELL J E.Direct thrombin inhibitors[J].Br J Clin Pharmacol,2011,72(4):581-592.
• [24] WADA T,YASUNAGA H,HORIGUCHI H,et al.Outcomes of argatroban treatment in patients with atherothrombotic stroke[J].Stroke,2016,47:471-476.
• [25] ANDREW D,GARY A,LOREN S,et al.Randomized,multicenter trial of ARTSS-2(argatroban with recombinant tissue plasminogen activatorfor acute stroke)[J].Stroke,2017,48(6):1608-1616.
• [26] WARKENTIN T E.Heparin-incluced thrombocytopenia incritcally ill patients[J].Semin Thromb Hemost,2015,41(1):49-60.
• [27] MINDLINA I,NELMES E,SHARP M.Argatroban to achieve therapeutic anticoagulation in two patients with acute thrombosis and heparin resistance[J].Blood Coagul Fibrinolysis,2019,30(8):426-428.