目的 觀察阿替普酶靜脈溶栓后再閉塞的腦卒中患者應用阿加曲班治療的臨床療效。方法 回顧性選擇2020年5月—2021年5月諸暨市人民醫(yī)院經(jīng)CT掃描確診的因大腦中動脈及分支狹窄或閉塞引發(fā)的早期急性腦卒中且經(jīng)阿替普酶靜脈溶栓后發(fā)生再閉塞的患者47例為研究對象，根據(jù)治療方法將患者分為對照組（n=24）和試驗組（n=23），兩組患者均用注射用阿替普酶溶栓治療（0.9 mg/kg），l min內靜脈注射總劑量的10%，剩余藥液于1 h內靜脈滴注完畢。對照組在阿替普酶溶栓治療24 h后靜脈滴注300 mL 0.9%氯化鈉溶液，每日1次；第3～7天改為靜脈滴注100 mL 0.9%氯化鈉溶液，每日1次。試驗組給予阿加曲班注射液10 mg加入至30 mL 0.9%氯化鈉溶液中，12.5 mL/h微泵靜推維持48 h，溶栓治療后的第3～7天阿加曲班注射液改為每日2次微泵靜推（每次用阿加曲班注射液10 mg加入至30 mL 0.9%氯化鈉溶液中，12.5 mL/h微泵靜推維持4 h）。兩組均在溶栓24 h后頭顱CT排除腦出血后常規(guī)給予腦卒中二級預防藥物。比較兩組臨床療效，分別采用美國國立衛(wèi)生研究院卒中量表（NIHSS）及日常生活能力量表（ADL）評估治療前后及治療后1個月兩組患者神經(jīng)功能缺損及日常生活活動能力。結果 試驗組總有效率95.7%顯著高于對照組的66.7%（P<0.05）；在治療后和治療后1個月，試驗組NIHSS評分、ADL評分與治療前比較，差異均有統(tǒng)計學意義（P<0.05）；試驗組治療后的NIHSS評分明顯低于對照組（P<0.05），ADL評分明顯高于對照組（P<0.05）。結論 阿加曲班可改善阿替普酶靜脈溶栓后再閉塞腦卒中患者的神經(jīng)功能，療效較好，改善患者日常生活質量，改善預后。

Objective To observe the clinical efficacy of argatroban in patients with stroke after intravenous thrombolysis with alteplase. Methods 47 patients with early acute cerebral infarction caused by stenosis or occlusion of middle cerebral artery and branches diagnosed by CT scan in Zhuji people's Hospital from May 2020 to May 2021 and reocclusion after intravenous thrombolysis with alteplase were selected as the research objects. According to the treatment method, the patients were divided into control group (n=24) and experimental group (n=23). Patients in both groups were treated with thrombolysis with alteplase for injection (0.9 mg/kg), 10% of the total dose was injected intravenously within 1 min, and the remaining solution was injected intravenously within 1 h. Patients in the control group were given 300 mL of 0.9% sodium chloride solution by intravenous drip once a day 24 hours after thrombolytic treatment with alteplase, and 100 mL of 0.9% sodium chloride solution were given by intravenous drip once a day on the 3rd to 7th days. Patients in the experimental group were given 10 mg of Argatroban Injection and added to 30 mL of 0.9% sodium chloride solution. The 12.5 mL/h micropump was pushed for 48 h. On the 3rd to 7th days after thrombolytic treatment with alteplase, Argatroban Injection were changed to micropump twice a day (Add 10 mg of Argatroban Injection to 30 mL of 0.9% sodium chloride solution each time, and push it with a micro pump at 12.5 mL/h for four hours). Patients in both groups were given secondary preventive drugs for cerebral infarction 24 h after thrombolysis. The clinical effects of the two groups were compared. The neurological deficit and activities of daily living of the two groups were evaluated by National Institutes of Health Stroke Scale (NIHSS) and activity of daily living scale (ADL) before treatment, after treatment and 1 month after treatment. Results the total effective rate of 95.7% in the experimental group was significantly higher than 66.7% in the control group (P<0.05). After treatment and one month after treatment, the NIHSS score and ADL score in the experimental group were significantly different from those before treatment (P<0.05). After treatment, the NIHSS score of the experimental group was significantly lower than that of the control group (P<0.05), and the ADL score was significantly higher than that of the control group (P<0.05). Conclusion Argatroban can improve the neurological function, improve the quality of daily life and prognosis of patients with cerebral infarction after intravenous thrombolysis with alteplase.

R971

諸暨市醫(yī)藥衛(wèi)生科技項目（2020YW033）