阿加曲班对早期急性脑梗死患者溶栓后的疗效分析
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摘要
目的观察阿加曲班对阿替普酶溶栓治疗的早期急性脑梗死患者的临床效果,探求急性脑梗死溶栓后的最佳药物选择及治疗方案。方法将采用阿替普酶溶栓治疗后的早期急性脑梗死患者60例随机分为对照组与试验组各30例。对照组静脉滴注依达拉奉30 mg/次,2次/d,连续7 d。试验组在对照组基础上静脉滴注阿加曲班,前2 d 60 mg/d,后5 d 20 mg/d。于治疗前、治疗7 d、治疗30 d时采用《脑卒中患者临床疗效评定标准》评价2组治疗效果,采用美国国立卫生研究院卒中量表(the National Institutes of Health Stroke Scale,NIHSS)评估神经功能缺损程度,采用日常生活能力量表(Activity of Daily Living Scale,ADL)评估日常生活质量,应用经颅多普勒超声评估脑血管再通情况。结果治疗后,2组NIHSS评分呈逐渐降低趋势,ADL评分和大脑中动脉血流速度呈逐渐升高趋势,试验组NIHSS评分低于对照组,ADL评分和大脑中动脉血流速度高于对照组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。结论与依达拉奉比较,阿加曲班+依达拉奉治疗阿替普酶溶栓后早期急性脑梗死患者,可有效降低神经功能缺损程度,改善日常生活质量和脑血管再通情况,提高治疗效果。
Objective To observed the clinical effect of argatroban on early acute cerebral infarction patients treated with alteplase thrombolytic therapy, and to explore the best drug and treatment after thrombolytic therapy for acute cerebral infarction patients. Methods Sixty early acute cerebral infarction patients treated with alteplase thrombolysis were randomly divided into control group and experimental group, 30 cases in each group. The control group received edaravone by intravenous drip, 30 mg/time, 2 times/d for 7 days. The experimental group received argatroban by intravenous drip on the basis of the control group, 60 mg/d for the first 2 days and 20 mg/d for the next 5 days. Before treatment, 7 and 30 days after treatment, the linical therapeutic effect of the two groups was evaluated by "Evaluating Criteria for the Clinical Efficacy of Stroke Patients", the degree of neurological impairment was assessed according to the National Institutes of Health Stroke Scale(NIHSS), the Daily life quality was assessed by Activity of Daily Living Scale(ADL), the state of cerebrovascular recanalization was evaluated by transcranial Doppler ultrasound. Results After treatment, the NIHSS score of the two groups showed decreased gradually trend, the ADL score and blood flow velocity of middle cerebral artery showed increased gradually trend, the NIHSS score of the experimental group was lower than that of the control group, the ADL score and blood flow velocity of middle cerebral artery were higher than that of the control group. There were statistical significance in the differences among intergroup, time point, intergroup-time point interaction(P<0.05). Conclusion Comparing with edaravone, the combination treament of argatroban and edaravone for early acute cerebral infarction patients treated with alteplase thrombolysis could effectively reduce the neurological impairment degree, improve the daily life quality and cerebral vascular recanalization, increase therapeutic effect.
Objective To observed the clinical effect of argatroban on early acute cerebral infarction patients treated with alteplase thrombolytic therapy, and to explore the best drug and treatment after thrombolytic therapy for acute cerebral infarction patients. Methods Sixty early acute cerebral infarction patients treated with alteplase thrombolysis were randomly divided into control group and experimental group, 30 cases in each group. The control group received edaravone by intravenous drip, 30 mg/time, 2 times/d for 7 days. The experimental group received argatroban by intravenous drip on the basis of the control group, 60 mg/d for the first 2 days and 20 mg/d for the next 5 days. Before treatment, 7 and 30 days after treatment, the linical therapeutic effect of the two groups was evaluated by "Evaluating Criteria for the Clinical Efficacy of Stroke Patients", the degree of neurological impairment was assessed according to the National Institutes of Health Stroke Scale(NIHSS), the Daily life quality was assessed by Activity of Daily Living Scale(ADL), the state of cerebrovascular recanalization was evaluated by transcranial Doppler ultrasound. Results After treatment, the NIHSS score of the two groups showed decreased gradually trend, the ADL score and blood flow velocity of middle cerebral artery showed increased gradually trend, the NIHSS score of the experimental group was lower than that of the control group, the ADL score and blood flow velocity of middle cerebral artery were higher than that of the control group. There were statistical significance in the differences among intergroup, time point, intergroup-time point interaction(P<0.05). Conclusion Comparing with edaravone, the combination treament of argatroban and edaravone for early acute cerebral infarction patients treated with alteplase thrombolysis could effectively reduce the neurological impairment degree, improve the daily life quality and cerebral vascular recanalization, increase therapeutic effect.
引文
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[12] 姜河,吴冬琴,林亚琴.急性缺血性脑卒中患者Hcy水平与神经功能缺损的相关性研究[J].河北医科大学学报,2017,38(4):382-385.
[13] 刘静,吴雅坤,吕宪民,等.急性脑梗死rt-PA溶栓治疗进展[J].河北医科大学学报,2016,37(3):355-357.
[14] Watanabe K,Tanaka M,Yuki S,et al.How is edaravone effective against acute ischemic stroke and amyotrophic lateral sclerosis?[J].J Clin Biochem Nutr,2018,62(1):20-38.
[15] Elbaradey GF,Elshmaa NS,Hodeib H.Role of edaravone in managemant of septic peritonitis[J].J Anaesthesiol Clin Pharmacol,2016,32(4):465-469.
[16] 靳伟.依达拉奉联用阿加曲班治疗急性脑梗死的临床疗效观察[J].安徽医药,2016,20(8):1579-1580,1581.
[17] 徐岗.阿加曲班对急性脑梗死患者神经功能缺损程度及凝血功能的影响[J].中国血液流变学杂志,2016,26(1):48-49.
[18] 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.
[2] Meng X,Wen R,Li X.Values of serum LDL and PCT levels in evaluating the condition and prognosis of acute cerebralinfarction[J].Exp Ther Med,2018,16(4):3065-3069.
[3] Lin ZJ,Qiu HY,Tong XX,et al.Evaluation of efficacy and safety of reteplase and alteplase in the trearment of hyper-acutecerebral infarction[J].Biosci Rep,2018,38(1).pii:BSR20170730.
[4] Wang J,Zhang Y,Xu F.Function and mechanism of microRNA-210 in acute cerebral infarction[J].Exp Ther Med,2018,15(2):1263-1268.
[5] Guvvala V,Chidambaram Subramanian V,Anireddy JS,et al.Novel degradation products of argatroban:Isolation,synthesis and extensive characterization using NMR and LC-PDA-MS/Q-TOF[J].J Pharm Anal,2018,8(2):86-95.
[6] Zeng Q,Fu QN,Li FH,et al.Early initiation of argatroban therapy in the management of acute superior mesenteric venous thrombosis[J].Exp Ther Med,2017,13(4):1526-1534.
[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[8] 王瑶.丁苯酞注射液联合依达拉奉治疗急性脑梗死的疗效观察[J].中国现代药物应用,2017,11(8):85-87.
[9] Guo YD,Huang T,Sheng WH,et al.Neuroprotective of recombinant adeno-associated virus human thioredoxin-PR39 on acutecerebral infarction in rats[J].Exp Ther Med,2018,16(3):2633-2638.
[10] Saito J,Koyama T,Domen K.Long-term outcomes of FIM motor items predicted from acute stage NIHSS of patients with middle cerebral artery infarct[J].Ann Rehabil Med,2018,42(5):670-681.
[11] Chen Y,Zhao Y.Curative sfficacy of penehyclidine combined with edaravone on acute cerebral infarction and their effects on serum TNF-α and NDS score in rats[J].Eur Rev Med Pharmacol Sci,2018,22(1):223-228.
[12] 姜河,吴冬琴,林亚琴.急性缺血性脑卒中患者Hcy水平与神经功能缺损的相关性研究[J].河北医科大学学报,2017,38(4):382-385.
[13] 刘静,吴雅坤,吕宪民,等.急性脑梗死rt-PA溶栓治疗进展[J].河北医科大学学报,2016,37(3):355-357.
[14] Watanabe K,Tanaka M,Yuki S,et al.How is edaravone effective against acute ischemic stroke and amyotrophic lateral sclerosis?[J].J Clin Biochem Nutr,2018,62(1):20-38.
[15] Elbaradey GF,Elshmaa NS,Hodeib H.Role of edaravone in managemant of septic peritonitis[J].J Anaesthesiol Clin Pharmacol,2016,32(4):465-469.
[16] 靳伟.依达拉奉联用阿加曲班治疗急性脑梗死的临床疗效观察[J].安徽医药,2016,20(8):1579-1580,1581.
[17] 徐岗.阿加曲班对急性脑梗死患者神经功能缺损程度及凝血功能的影响[J].中国血液流变学杂志,2016,26(1):48-49.
[18] 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.