摘要
目的 探讨超早期应用阿加曲班治疗急性缺血性脑卒中静脉溶栓后早期神经功能恶化(END)的疗效及安全性。方法 回顾性选取2018年1月—2021年7月在涿州市医院神经内科诊治的发病6 h内急性缺血性脑卒中行尿激酶静脉溶栓治疗后神经功能恶化患者90例,根据患者神经功能恶化时是否使用阿加曲班治疗分为对照组(n=45)及试验组(n=45),对照组在常规治疗基础上应用注射用尿激酶1.50×106U溶于100 mL 0.9%氯化钠注射液中,静脉滴注30 min,进行静脉溶栓治疗,溶栓24 h后复查头颅CT排除脑出血后启动口服阿司匹林肠溶片,每次100 mg,每日1次,持续服用14 d。试验组在对照组基础上加用阿加曲班治疗,溶栓24 h内发现脑血管病进展,即启动阿加曲班注射液抗凝治疗。具体用法:阿加曲班注射液治疗前2 d用120 mg原液以2.5 mg·h^(-1)持续静脉泵入48 h;治疗第3天开始改为阿加曲班注射液每次10 mg加入至0.9%氯化钠注射液250 mL中,持续静脉滴注3 h,每日2次,连用5 d,阿加曲班注射液共用药7 d;静脉溶栓24 h后启动阿司匹林肠溶片治疗,用法用量及疗程同对照组。应用美国国立卫生研究院卒中量表(NIHSS)评分比较两组不同时间点(尿激酶静脉溶栓前、溶栓治疗后神经功能恢复最好时、神经功能恶化时和应用阿加曲班干预治疗第7、14天)神经功能缺损情况,出院后第90天应用改良Rankin量表(mRS)对所有患者的日常生活能力恢复情况进行评估,以mRS评分>2分为预后不良,mRS评分≤2分为预后良好,评估住院期间所有患者是否存在脑出血及死亡等并发症。结果 应用阿加曲班干预治疗的试验组患者的治疗总有效率为97.78%,显著高于对照组的82.22%,两组总有效率比较,差异显著(P<0.05)。静脉溶栓前、溶栓后神经功能恢复最好时、溶栓后神经功能恶化时,两组NIHSS评分差异无统计学意义(P>0.05);在阿加曲班干预治疗第7、14天,对照�
Objective To investigate the clinical efficacy and safety of ultra-early application of argatroban in the treatment of early neurological deterioration(END) after urokinase intravenous thrombolysis in acute ischemic stroke. Methods A total of 90 patients with early neurological deterioration after intravenous thrombolytic therapy with urokinase in acute ischemic stroke treated in the Department of Neurology of Zhuozhou hospital from January 2018 to July 2021 were selected retrospectively. According to whether the patients were treated with argatroban or not, they were divided into control group(n = 45) and experimental group(n = 45).Patients in the control group were treated with Urokinase for Injection on the basis of routine treatment, Urokinase for Injection1.50 × 106U was dissolved in 100 mL of 0.9% Sodium Chloride Injection, intravenous drip for 30 min, intravenous thrombolysis treatment, 24 h after thrombolysis, recheck the head CT, and start oral Aspirin Enteric Coated Tablets after excluding intracerebral hemorrhage, 100 mg each time, once a day, for 14 d. Patients in the experimental group were treated with argatroban on the basis of the control group. If the progress of cerebrovascular disease was found within 24 h of thrombolysis, the anticoagulant treatment of Argatroban Injection was started. Specific usage: Argatroban Injection was continuously pumped intravenously with 120 mg stock solution at 2.5 mg·h^(-1) for 48 h two days before treatment. Starting from the third day of treatment, it was changed to add 10 mg of Argatroban Injection to 250 mL of 0.9% Sodium Chloride Injection. It was continuously injected intravenously for three hours, twice a day, for five days. Argatroban Injection shared the drug for seven days. Aspirin Enteric Coated Tablets were started 24 h after intravenous thrombolysis. The usage, dosage and course of treatment were the same as those in the control group. The National Institutes of Health Stroke Scale(NIHSS) score was used to compare the neurological deficit of the two
作者
潘海燕
张涛
PAN Haiyan;ZHANG Tao(Department of Neurology,Zhuozhou Hospital,Baoding 072750,China;Department of Cardiology,Zhuozhou Hospital,Baoding 072750,China)
出处
《药物评价研究》
CAS
2022年第4期752-758,共7页
Drug Evaluation Research
基金
2021年保定市科技局自筹项目课题(2141ZF176)。
关键词
阿加曲班
静脉溶栓
超早期
早期神经功能恶化
临床疗效
预后
agatroban
intravenous thrombolysis
ultra early stage
early neurological deterioration
clinical efficacy
prognosis
