目的 觀察阿加曲班聯(lián)合阿替普酶治療急性腦卒中的療效及其對氧化應激和炎癥因子的影響。方法 回顧性選取2018年6月—2020年12月徐州醫(yī)科大學附屬連云港東方醫(yī)院收治的急性腦卒中患者84例，發(fā)病均在4.5 h內(nèi)，根據(jù)治療方法將患者分為對照組（n=42）和觀察組（n=42）。對照組給予注射用阿替普酶（0.9 mg/kg為其標準劑量，最大使用劑量不超過90 mg）靜脈溶栓及常規(guī)治療，觀察組在對照組的基礎(chǔ)上靜脈溶栓24 h后加用阿加曲班注射液治療，第1～2天，阿加曲班注射液60 mg靜脈滴注24 h；第3～7天，阿加曲班注射液10 mg靜脈滴注3 h，2次/d，兩組患者治療療程均為14 d。分別于治療前和治療14 d后采用美國國立衛(wèi)生研究院卒中量表（NIHSS）和改良Barthel指數(shù)量表（MBI）對兩組患者神經(jīng)功能缺損和日常生活能力進行評分，檢測兩組患者的氧化應激標志物超氧化物歧化酶（SOD）和丙二醛（MDA）水平，檢測血清炎癥標志物白細胞介素-6（IL-6）和腫瘤壞死因子-α（TNF-α）水平，監(jiān)測出血性轉(zhuǎn)化（HT）發(fā)生率及藥物的不良反應。結(jié)果 治療14 d后，觀察組的總有效率高于對照組（P<0.05）；兩組患者的NIHSS評分及血清MDA、IL-6及TNF-α水平均較治療前明顯下降（P<0.01），MBI評分及SOD水平較治療前明顯升高（P<0.01），且觀察組相比對照組改善作用更加明顯（P<0.01）。兩組患者治療14 d內(nèi)，HT發(fā)生率及不良反應發(fā)生率比較差異均無統(tǒng)計學意義。結(jié)論 阿加曲班注射液具有抗炎、抑制氧化應激作用，聯(lián)合阿替普酶治療急性腦卒中安全有效，與單獨阿替普酶靜脈溶栓治療相比，可顯著改善預后，且未增加HT風險及不良反應發(fā)生率。

Objective To observe the efficacy of argatroban combined with alteplase in the treatment of acute stroke and its effects on oxidative stress and inflammatory factors. Methods Totally 84 patients with acute stroke treated in Lianyungang Oriental Hospital Affiliated to Xuzhou Medical University from June 2018 to December 2020 were selected retrospectively. All of them were within 4.5 h. According to the treatment methods, the patients were divided into control group (n=42) and observation group (n=42). Patients in the control group were given intravenous thrombolysis and routine treatment with alteplase for injection (0.9 mg/kg as the standard dose, and the maximum dose was no more than 90 mg). Patients in the observation group were treated with Argatroban Injection after intravenous thrombolysis for 24 h on the basis of the control group. On the first to second days, 60 mg Argatroban Injection was injected intravenously for 24 h, on the 3rd-7th day, Argatroban Injection 10 mg was injected intravenously for three hours, twice a day. The treatment course of both groups was 14 days. The neurological deficits and activities of daily living of the two groups were scored by National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (MBI) before and 14 days after treatment. The levels of oxidative stress markers superoxide dismutase (SOD) and malondialdehyde (MDA) and serum inflammatory markers interleukin-6 (IL-6) were detected And tumor necrosis factor-α (TNF- α). Results After 14 days of treatment, the total effective rate of the observation group was higher than that of the control group (P<0.05), the NIHSS score, serum MDA, IL-6 and TNF-a levels of the two groups were significantly lower than those before treatment (P<0.01), and the MBI score and SOD level were significantly higher than those before treatment (P<0.01). There was no significant difference in the incidence of HT and adverse reactions between the two groups within 14 d of treatment. Conclusion Argatroban Injection has antiinflammatory and anti-oxidative stress effects. It is safe and effective in the treatment of acute stroke combined with alteplase. Compared with intravenous thrombolysis with alteplase alone, it can significantly improve the prognosis without increasing the risk of HT and the incidence of adverse reactions.

R971