目的 比較阿加曲班和低分子肝素治療下肢動(dòng)脈硬化閉塞癥合并血栓的臨床療效。方法 選取2017年1月-2017年9月在中國(guó)醫(yī)科大學(xué)附屬第一醫(yī)院治療的下肢動(dòng)脈硬化閉塞癥合并血栓患者60例，隨機(jī)分為對(duì)照組（30例）和治療組（30例）。兩組患者給予基礎(chǔ)溶栓治療，經(jīng)溶栓導(dǎo)管泵入注射用尿激酶，20~40萬(wàn)U加入到生理鹽水中配成100 mL溶液，50 mL/h，2次/d。對(duì)照組患者在基礎(chǔ)溶栓的基礎(chǔ)上皮下注射低分子肝素鈣4 100 AXaIU，2次/d；治療組患者在基礎(chǔ)溶栓的基礎(chǔ)上經(jīng)溶栓導(dǎo)管泵入阿加曲班注射液，40 mg加入到生理鹽水320 mL中，20 mL/h，1次/d。兩組患者均連續(xù)治療7 d。評(píng)價(jià)兩組患者臨床療效，同時(shí)比較治療前后兩組患者踝肱指數(shù)（ABI）、跛行距離和D-二聚體水平以及并發(fā)癥和不良反應(yīng)。結(jié)果 治療后，對(duì)照組和治療組的總有效率分別為73.33%、93.33%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者的ABI和跛行距離均顯著升高，同組治療前后差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組的跛行距離顯著高于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療第7天，兩組患者的D-二聚體水平均顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療第3天，治療組的D-二聚體水平較治療前顯著降低，且顯著低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。對(duì)照組和治療組的并發(fā)癥發(fā)生率分別為6.67%、3.33%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。對(duì)照組和治療組的不良反應(yīng)發(fā)生率分別為13.33%、0，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 阿加曲班聯(lián)合尿激酶經(jīng)導(dǎo)管溶栓治療下肢動(dòng)脈粥樣硬化閉塞癥合并血栓療效顯著，能明顯改善相應(yīng)癥狀，同時(shí)具有更好的安全性。

Objective To compare the clinical effect between argatroban and low molecular weight heparin in treatment of lower extremity atherosclerotic occlusive disease with thrombus. Methods Patients (60 cases) with lower extremity atherosclerotic occlusive disease with thrombus in The First Affiliated Hospital of China Medical University from January 2017 to September 2017 were randomly divided into control (30 cases) and treatment (30 cases) groups. Patients in two groups were pumped with Urokinase for injection by infusion catheter as basic thrombolysis, 2.0×10⁴-4.0×10⁴ units added into normal saline 100 mL, 50 mL/h, twice daily. Patients in the control group were subcutaneous injection administered with Low-molecular-weight Heparin Calcium Injection on the basis of basic thrombolysis, 4 100 AXaIU/time, twice daily. Patients in the treatment group were pumped with Argatroban Injection on the basis of basic thrombolysis, 40 mg added into normal saline 320 mL, 20 mL/h, once daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the ABI, limping distance, D-dimer level, complication, and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 73.33% and 93.33%, respectively, and there was difference between two groups (P<0.05). ABI and limping distance in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And limping distance in the treatment group was higher than that in the control group, with significant difference between two groups (P<0.05). On the treatment for 7 d, D-dimer level in two groups was significantly increased, and the difference was statistically significant in the same group (P<0.05). On the treatment for 3 d, D-dimer level in the treatment group was significantly decreased, and was lower than that in the control group, with significant difference between two groups (P<0.05). The rate of adverse reactions in the control and treatment groups were 13.33% and 0, respectively, and there was significant differencebetween two groups (P<0.05). Conclusion Argatroban combined with urokinase by infusion catheter thrombolysis has good effect in treatment of lower extremity atherosclerotic occlusive disease with thrombus, and can improve corresponding symptoms with good safety.