阿加曲班治疗不同脑组织缺血范围进展性脑卒中的临床观察
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篇名: 阿加曲班治疗不同脑组织缺血范围进展性脑卒中的临床观察
TITLE:
摘要: 目的:研究不同脑组织缺血范围进展性脑卒中患者采用阿加曲班治疗的临床效果。方法:选择2015年2月-2016年5月我院神经内科收治的进展性脑卒中患者116例,根据脑组织缺血范围分为前循环(缺血)组60例、后循环(缺血)组50例、腔隙性(脑梗死)组6例。3组患者均采用基础治疗联合阿加曲班治疗,于病情加重当天及第2天采用阿加曲班60 mg/d静脉持续泵入,病情缓解后的第5天减量为10 mg经静脉持续泵入治疗,3 h/次,bid,7 d为1个疗程。比较3组患者美国国立卫生院卒中量表(NIHSS)评分、改良RANKIN量表(mRS)评分、活化部分凝血活酶时间(APTT)及不良反应发生情况。结果:治疗后14 d,3组患者NIHSS、mRS评分均较治疗前显著降低,差异均有统计学意义(P<0.05);且前循环组与后循环组比较,差异有统计学意义(P<0.05)。治疗2 h时,3组患者APTT均较治疗前显著延长,且腔隙性组最为明显,组间比较差异有统计学意义(P<0.05);治疗48 h时,3组患者APTT均恢复至正常水平,组间比较差异无统计学意义(P>0.05)。3组患者均未见明显不良反应发生。结论:阿加曲班治疗不同脑组织缺血范围的进展性脑卒中均能取得显著疗效,且安全性高;尤其是针对前循环缺血性脑卒中患者显效快、抗凝效果显著。
ABSTRACT: OBJECTIVE: To study clinical effect of argatroban for progressive stroke patients of different cerebral ischemic ranges. METHODS: A total of 116 progressive stroke patients selected from neurology department of our hospital during Feb. 2015-May 2016 were divided into anterior circulation (ischemia) group (n=60), posterior circulation (ischemia) group (n=50) and lacunar (cerebral infarction) group (n=6) according to cerebral ischemic ranges. They all received routine treatment combined with argatroban, and given continuous intravenous infusion of argatroban 60 mg/d on the day and 2nd day of disease aggravation, and then continuous intravenous infusion of argatroban  5th day after relieving, 3 h/time, bid, 7 d as a treatment course. NIHSS scores, modified RANKIN (mRS) scores, APTT and ADR were compared among 3 groups. RESULTS: Forteen days after treatment, NIHSS scores and mRS scores of 3 groups were decreased significantly compared to before treatment, with statistical significance (P<0.05). There was statistical significance between anterior circulation group and posterior circulation group (P<0.05). Two hours after treatment, APTT of 3 groups were prolonged significantly, especially in lacunar group, with statistical significance (P<0.05). Forty hours after treatment, APTT of 3 groups were recover to normal, without statistical significance (P>0.05). No obvious ADR was found in 3 groups. CONCLUSIONS: Argatroban shows significant therapeutic efficacy for progressive stroke of different ischemic ranges with good safety; especially for the patients with anterior circulation ischemics stroke, the effect is quick and anticoagulant effect is significant.  
期刊: 2017年第28卷第17期
作者: 冯湧,于学超,孟虹媛,张同华
AUTHORS: FENG Yong,YU Xuechao,MENG Hongyuan,ZHANG Tonghua
关键字: 前循环缺血性脑卒中;后循环缺血性脑卒中;腔隙性脑梗死;阿加曲班
KEYWORDS: Anterior circulation ischemics stroke; Posterior circulation ischemics stroke; Lacunar cerebral infarction; Argatroban
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