目的 探討阿替普酶聯(lián)合阿加曲班治療急性缺血性腦卒中的治療效果以及風(fēng)險(xiǎn)性。方法 采用回顧性分析方法，選取2019年6月－2020年6月邢臺(tái)市第三醫(yī)院收治的在溶栓時(shí)間窗的急性缺血性腦卒中患者100例作為研究對(duì)象，根據(jù)治療方法將患者分為對(duì)照組（n=50）和觀察組（n=50）。兩組患者均給予常規(guī)基礎(chǔ)治療，對(duì)照組給予注射用阿替普酶靜脈溶栓治療，按照0.9 mg/kg（最大劑量為90 mg）給藥，其中10%于1 min內(nèi)靜脈推注完畢，其余90%藥液在1 h內(nèi)靜脈泵入。溶栓24 h后復(fù)查頭顱CT無出血后，給予阿司匹林治療。觀察組在對(duì)照組基礎(chǔ)上加用阿加曲班注射液治療，第1～2天予以60 mg/d阿加曲班稀釋后持續(xù)靜脈泵注（速度2.5 mg/h），其后阿加曲班注射液10 mg于生理鹽水20 mL中持續(xù)靜脈泵入3 h，2次/d。兩組均持續(xù)治療7 d。記錄兩組患者治療前及溶栓后1 h、治療后7 d、治療后3個(gè)月的美國國立衛(wèi)生研究院卒中量表（NIHSS）評(píng)分以及治療前及治療后3個(gè)月改良Rankin量表（mRS）評(píng)分，記錄治療期間不良反應(yīng)發(fā)生情況。結(jié)果 治療后，觀察組總有效率為90.0%，顯著高于對(duì)照組的74.0%（P<0.05）。治療后，兩組NIHSS、mRS評(píng)分均改善，觀察組治療后3個(gè)月NIHSS評(píng)分和mRS評(píng)分均顯著低于對(duì)照組（P<0.05、0.01）。兩組治療期間不良反應(yīng)總發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 阿替普酶聯(lián)合阿加曲班治療急性缺血性腦卒中臨床效果顯著，能有效減輕患者神經(jīng)功能受損癥狀，提高生活質(zhì)量且安全性良好，值得臨床應(yīng)用推廣。

Objective To investigate the therapeutic effect and risk of alteplase combined with argatroban in the treatment of acute ischemic stroke. Methods 100 patients with acute ischemic stroke in thrombolysis time window treated in Xingtai Third Hospital from June 2019 to June 2020 were selected as the research objects. According to the treatment methods, the patients were divided into control group (n=50) and observation group (n=50). The patients in both groups were given routine basic treatment. The control group was given intravenous thrombolysis with alteplase for injection at the dose of 0.9 mg/kg (the maximum dose was 90 mg), of which 10% were injected intravenously within 1 min, and the other 90% were pumped intravenously within 1 h. After 24 h of thrombolysis, the patients were given aspirin treatment after reexamination of cranial CT without bleeding. Patients in the observation group were treated with Argatroban Injection on the basis of the control group. On the first to second days, 60 mg/d argatroban was diluted and continuously pumped intravenously (at a rate of 2.5 mg/h), and then 10 mg argatroban was continuously pumped intravenously in 20 mL normal saline for 3 h, twice a day. Patients in both groups were treated for seven days. The National Institutes of Health Stroke Scale (NIHSS) scores and the modified Rankin Scale (mRS) scores before and 3 months after treatment were recorded. The adverse reactions during treatment were recorded. Results After treatment, the total effective rate in the observation group was 90.0%, significantly higher than 74.0% in the control group (P<0.05). After treatment, the NIHSS and mRS scores of the two groups were improved. The NIHSS and mRS scores of the observation group were significantly lower than those of the control group three months after treatment (P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups. Conclusion The clinical effect of alteplase combined with argatroban in the treatment of acute ischemic stroke is significant. It can effectively reduce the symptoms of impaired neurological function, improve the quality of life, and has good safety. It is worthy of clinical application and promotion.

R971

邢臺(tái)市市級(jí)科技計(jì)劃自籌經(jīng)費(fèi)項(xiàng)目（2019ZC200）