目的 觀察新型凝血酶抑制劑阿加曲班聯(lián)合抗血小板藥硫酸氫氯吡格雷對(duì)急性后循環(huán)缺血性腦卒中患者血液高凝狀態(tài)、血小板（PLT）計(jì)數(shù)、美國(guó)國(guó)立衛(wèi)生研究院卒中量表（NIHSS）評(píng)分和Barthel指數(shù)（BI）的影響。方法 回顧性選取2020年9月-2021年8月揭陽(yáng)市人民醫(yī)院神經(jīng)內(nèi)科診治的急性后循環(huán)缺血性腦卒中患者70例為研究對(duì)象，根據(jù)治療方法分為對(duì)照組和試驗(yàn)組，每組各35例，兩組患者的血壓、血糖都嚴(yán)格依照急性缺血性腦卒中治療指南予以監(jiān)測(cè)管理，同時(shí)使用穩(wěn)定斑塊等藥物。對(duì)照組口服硫酸氫氯吡格雷片，每次75 mg，每天1次，持續(xù)服用14 d。試驗(yàn)組在對(duì)照組基礎(chǔ)上加用阿加曲班注射液，在開(kāi)始治療的第1~2天，阿加曲班注射液60 mg加入至0.9%氯化鈉注射液380 mL中，輸液泵泵入，24 h持續(xù)不間斷靜脈輸注，從第3天起，阿加曲班注射液10 mg加入至0.9%氯化鈉注射液250 mL中，輸液泵泵入，持續(xù)3 h靜脈輸注，間隔12 h再輸注1次，持續(xù)用藥5 d，阿加曲班注射液共用藥7 d。采用NIHSS評(píng)分評(píng)估兩組患者的神經(jīng)缺損程度，采用BI指數(shù)評(píng)估兩組患者日常生活自理能力。動(dòng)態(tài)檢測(cè)兩組患者凝血三項(xiàng)[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）]和血小板計(jì)數(shù)（PLT）。觀察記錄用藥過(guò)程中兩組患者不良反應(yīng)發(fā)生情況。結(jié)果 治療14 d，試驗(yàn)組總有效率91.43%，對(duì)照組總有效率68.57%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療前，兩組患者NIHSS評(píng)分及BI指數(shù)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。治療后兩組患者NIHSS評(píng)分均較治療前明顯降低（P<0.05），且治療后試驗(yàn)組NIHSS評(píng)分顯著低于對(duì)照組（P<0.05）；治療后兩組患者BI指數(shù)均較治療前明顯升高（P<0.05），且治療后試驗(yàn)組BI指數(shù)顯著高于對(duì)照組（P<0.05）。與用藥前和對(duì)照組相比，試驗(yàn)組在應(yīng)用阿加曲班注射液第1天（60 mg·d^-1），TT、PT、APTT均明顯延長(zhǎng)（P<0.05）；用藥第3天，即減量為20 mg·d^-1，TT、PT、APTT較用藥第1天均明顯縮短（P<0.05），但較治療前和對(duì)照組有所延長(zhǎng)（P<0.05）；停藥第2天，TT、PT、APTT均恢復(fù)至治療前水平。PLT在阿加曲班注射液用藥前、用藥期間（60 mg·d^-1、20 mg·d^-1）、停藥后無(wú)明顯變化，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。對(duì)照組凝血三項(xiàng)和PLT在各檢測(cè)時(shí)間點(diǎn)均無(wú)明顯變化，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組患者在治療期間未發(fā)生過(guò)敏性休克、出血、心律失常等與治療藥物相關(guān)的不良反應(yīng)。結(jié)論 阿加曲班注射液聯(lián)合硫酸氫氯吡格雷能夠有效抑制血栓形成而不影響正常的凝血功能，明顯改善急性后循環(huán)缺血性腦卒中患者的高凝狀態(tài)，抗血栓再次形成能力強(qiáng)，安全性好；患者神經(jīng)功能缺損情況明顯改善，日常獨(dú)立生活能力得到提高，病情得到有效控制。阿加曲班注射液聯(lián)合硫酸氫氯吡格雷是一種有效的治療急性后循環(huán)缺血性腦卒中方法，有較高的臨床推廣應(yīng)用價(jià)值。

Objective To observe the effects of new thrombin inhibitor argatroban combined with antiplatelet drug clopidogrel bisulfate on blood hypercoagulability, platelet (PLT) count, National Institutes of Health Stroke Scale (NIHSS) score and Barthel Index (BI) in patients with acute posterior circulation ischemic stroke. Methods A total of 70 patients with acute posterior circulation ischemic stroke treated in the Department of Neurology of Jieyang People's Hospital from September 2020 to August 2021 were selected retrospectively. According to the treatment method, they were divided into control group and experimental group, with 35 cases in each group. Blood glucose was monitored and managed in strict accordance with the guidelines for the treatment of acute ischemic stroke, and drugs such as plaque stabilization were used at the same time. Patients in the control group were took Clopidogrel Bisulfate Tablets orally, 75 mg each time, once a day for 14 days. Patients in the experimental group were added with Argatroban Injection on the basis of the control group. On the first to second days of treatment, 60 mg of Argatroban Injection was added to 380 mL of 0.9% sodium chloride injection, pumped by infusion pump and continuously infused intravenously for 24 h. From the third day, 10 mg of Argatroban Injection was added to 250 mL of 0.9% sodium chloride injection, pumped by infusion pump and continuously infused intravenously for three hours, another infusion was given at an interval of 12 h for five days, and agatroban shared the drug for seven days. NIHSS score was used to evaluate the degree of nerve defect of patients in the two groups, and BI was used to evaluate the self-care ability of daily life of patients in the two groups. Three coagulation items[thrombin time (TT), prothrombin time (PT), activated partial prothrombin time (APTT)] and platelet (PLT) counts were dynamically measured in the two groups. The adverse reactions of the two groups were observed and recorded. Results After 14 d of treatment, the total effective rate was 91.43% in the experimental group and 68.57% in the control group. There was significant difference between the two groups (P < 0.05). Before treatment, there was no significant difference in NIHSS score and BI between the two groups (P > 0.05). The NIHSS score of the two groups after treatment was significantly lower than that before treatment (P < 0.05), and the NIHSS score of the experimental group was significantly lower than that of the control group (P < 0.05). After treatment, the BI of the two groups was significantly higher than that before treatment (P < 0.05), and the BI of the experimental group was significantly higher than that of the control group (P < 0.05). Compared with the pre-medication and control group, TT, PT and APTT in the experimental group were significantly prolonged on the first day (Argatroban Injection 60 mg·d^-1) (P < 0.05). On the third day of treatment (Argatroban Injection 20 mg·d^-1), TT, PT and APTT were significantly shorter than those on the first day of treatment (P < 0.05), but longer than those before treatment and the control group (P < 0.05). On the second day after drug withdrawal, TT, PT and APTT returned to the level before treatment. There was no significant change in PLT count before and during argatroban treatment and after drug withdrawal (P > 0.05). In the control group, there was no significant change in the three items of coagulation and PLT count at each detection time point, and the difference was not statistically significant (P > 0.05). There were no adverse reactions related to therapeutic drugs, such as anaphylactic shock, bleeding, arrhythmia and so on. Conclusion Argatroban combined with clopidogrel bisulfate can effectively inhibit thrombosis without affecting the normal coagulation function, significantly improve the hypercoagulable state of patients with acute posterior circulation ischemic stroke, have strong antithrombosis ability and good safety. Argatroban combined with clopidogrel bisulfate is an effective method for the treatment of acute posterior circulation ischemic stroke, which has high clinical application value.

R971