目的 探討阿加曲班聯(lián)合阿司匹林和氯吡格雷治療急性進(jìn)展性腦梗死的臨床療效。方法 選取2021年7月—2022年6月揭陽(yáng)市人民醫(yī)院神經(jīng)內(nèi)科診治的急性進(jìn)展性腦梗死患者80例，根據(jù)隨機(jī)數(shù)字表法分成對(duì)照組和治療組，每組各40例。對(duì)照組口服阿司匹林腸溶片100 mg/次，1次/d，口服硫硫酸氫氯吡格雷片，75 mg/次，1次/d。治療組在對(duì)照組的基礎(chǔ)上靜脈滴注阿加曲班注射液，阿加曲班注射液60 mg加入生理鹽水380 mL，輸液泵維持24 h，用藥2 d；第3～7天，阿加曲班注射液10 mg加入生理鹽水250 mL輸液泵維持3 h靜脈滴注，每12小時(shí)1次。兩組患者均治療2周。觀察兩組的臨床療效，比較兩組美國(guó)國(guó)立衛(wèi)生研究院卒中量表（NIHSS）、巴氏指數(shù)（BI）、血清炎癥因子和凝血三項(xiàng)的變化情況。結(jié)果 治療后，治療組患者總有效率92.5%，顯著高于對(duì)照組的72.5%（P＜0.05）。治療后，兩組患者NIHSS評(píng)分均較治療前明顯降低，BI指數(shù)均較治療前明顯升高（P＜0.05）；且治療后，治療組NIHSS評(píng)分低于對(duì)照組，BI指數(shù)顯著高于對(duì)照組（P＜0.05）。治療后，兩組患者白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）、超敏C反應(yīng)蛋白（hs-CRP）水平較治療前明顯降低（P＜0.05），且治療后治療組IL-6、TNF-α、hs-CRP水平顯著低于對(duì)照組（P＜0.05）。治療前后同組患者凝血酶時(shí)間（TT）、凝血酶原時(shí)間（PT）、活化部分凝血酶原時(shí)間（APTT）水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義；治療后，兩組患者凝血三項(xiàng)指標(biāo)比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 阿加曲班聯(lián)合阿司匹林和氯吡格雷雙抗治療急性進(jìn)展性腦梗死具有較好的臨床療效，能減輕血管炎癥反應(yīng)，降低炎癥反應(yīng)，有較高的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the effect of argatroban combined with aspirin and clopidogrel in treatment of acute progressive cerebral infarction. Methods A total of 80 patients with acute progressive cerebral infarction diagnosed and treated in the Department of Neurology of Jieyang People’s Hospital from July 2021 to June 2022 were selected and divided into control group and treatment group according to random number table method, with 40 cases in each group. Patients in the control group were po administered with Aspirin Enteric Coated Tablets, 100 mg/time, once daily, Clopidogrel Hydrogen Sulphate Tablets 75 mg/time, once daily. Patients in the treatment group were iv administered with Agatuban Injection, adding 60 mg Agatuban Injection to 380 mL normal saline, maintained for 24 h with infusion pump, and treated for 2 d. On days 3 to 7, 10 mg of Agatuban Injection was added to 250 mL normal saline infusion pump for 3 h of intravenous infusion, once every 12 h. Both groups were treated for 2 weeks. The clinical efficacy of the two groups was observed, and the changes of the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), serum inflammatory factors and coagulation were compared between the two groups. Results After treatment, the total effective rate of the treatment group was 92.5%, which was significantly higher than that of the control group (72.5%, P < 0.05). After treatment, NIHSS score in 2 groups was significantly lower than before treatment, but BI index was significantly higher than before treatment (P < 0.05). After treatment, NIHSS score in the treatment group was lower than that in the control group, but BI index was significantly higher than that in the control group (P < 0.05). After treatment, the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and hypersensitive C-reactive protein (hs-CRP) in two groups were significantly decreased compared with before treatment (P < 0.05), and after treatment, the levels of IL-6, TNF-α, and hs-CRP in treatment group were significantly lower than those in control group (P < 0.05). There was no significant difference in the levels of thrombin time (TT), prothrombin time (PT) and activated partial prothrombin time (APTT) before and after treatment. After treatment, there was no significant difference in the three indexes of blood coagulation between the two groups. Conclusion Argatroban combined with aspirin and clopidogrel has good clinical efficacy in treatment of acute progressive cerebral infarction, and can reduce vascular inflammatory response and reduce inflammatory response, which has high clinical application value.

R971