摘要
目的:分析阿加曲班对后循环脑梗死患者血液流变学、神经功能缺损程度及日常生活活动能力的影响.方法:选取本院2017年9月至2019年9月收治的120例后循环脑梗死患者,采用简单随机分组法,分为对照组采取常规治疗和治疗组应用阿加曲班+常规治疗,两组各60例.比较两组治疗前后血液流变学指标、美国国立卫生研究院卒中量表(NIHSS)、改良Barthel指数(MBI)评分等差异.治疗期间,治疗组行血栓弹力图和凝血功能检测,以评估阿加曲班治疗对患者凝血功能的改善效果.结果:治疗后3个月,对照组红细胞比容(Hct)和全血相对切变率指数(高切)较治疗前均显著下降(P<0.05),而治疗后血浆黏度和全血黏度切变率(高切)与治疗前比较,均无明显变化(P>0.05);治疗组治疗后3个月Hct、血浆黏度、全血相对切变率指数(高切)、全血黏度切变率(高切)较治疗前均显著下降,且治疗后各项指标较对照组均显著下降(P<0.05).两组治疗后3个月NIHSS评分较治疗前均显著下降,且治疗组治疗后的下降幅度较对照组更加明显(P<0.05);与治疗前比较,两组治疗后3个月MBI评分均显著提高,且治疗组治疗后的升高幅度较对照组更加明显(P<0.05).阿加曲班用药60mg/d时,治疗组凝血酶时间、凝血酶原时间、活化部分凝血酶原时间(APTT)均明显延长,阿加曲班用药30mg/d和停药2d时,凝血酶时间、凝血酶原时间及APTT均显著缩短;不同时间点各项凝血功能指标的比较,具有统计学意义(P<0.05).阿加曲班用药60mg/d时,治疗组凝血综合指数明显降低,凝血因子活性明显提高,而在阿加曲班用药30mg/d和停药2d时,复查凝血综合指数和凝血因子活性均恢复至正常范围(P<0.05).结论:应用阿加曲班治疗可有效改善后循环脑梗死患者血液流变学和凝血功能,减轻神经功能缺损程度,提高日常生活活动能力,且具有良好的安全性,因此值得临床应用.
Objective:To analyze the effect of argatroban on hemorheology,neurological deficit and activity of daily life in patients with posterior circulation cerebral infarction.Methods:A total of 120 patients with posterior circulation cerebral infarction admitted to our hospital from September 2017 to September 2019 were randomly divided into two groups by simple random grouping method:the control group was treated in conventional manner and the treatment group was administered argatroban+conventional.The hemorheology indexes,National Institutes of Health Stroke Scale(NIHSS)and the modified Barthel Index(MBI)of the two groups were compared before and after treatment.During the treatment,thromboelastography and coagulation function were performed in the treatment group to evaluate the effect of agatraban on the improvement of coagulation function.Results:Three months after treatment,Hct and whole blood relative shear rate index(high shear)in the control group were significantly reduced compared with corresponding data before treatment(P<0.05),but there was no significant change in plasma viscosity and the shear rate of whole blood viscosity(high shear).The Hct,plasma viscosity,whole blood relative shear rate index(high shear)and shear rate of whole blood viscosity(high shear)were significantly reduced compared with corresponding data before treatment,and each index after treatment was significantly reduced compared with control group(P<0.05).The NIHSS scores of the two groups decreased significantly after 3 months of treatment,and the decrease range of the treatment group after treatment was more significant compared with control group(P<0.05);compared with corresponding data before treatment,the MBI scores of the two groups after 3 months of treatment were significantly increased,and the increase range of the treatment group after treatment was more significant compared with control group(P<0.05).The prothrombin time,prothrombin time and activated partial thromboplastin time(APTT)in the treatment group were significantly prolonged compared with control group at 60 mg/d,while the prothrombin time,prothrombin time and APTT were significantly shorter at 30 mg/d and 2 d after stopping treatment.The comparison of coagulation function indexes at different time points was statistically significant(P<0.05).After 60 mg/d,the coagulation index and the activity of coagulation factors in the treatment group decreased significantly,while after 30 mg/d and 2 days of withdrawal,the coagulation index and the activity of coagulation factors returned to the normal range(P<0.05).Conclusion:The application of argatroban can effectively improve the hemorheology and coagulation function of patients with post circulation cerebral infarction,reduce the degree of neurological deficit,improve the ability of daily life activities,and has good safety,so it is worth clinical application.
作者
柳春雨
武建宏
杨晓丹
LIU Chunyu;WU Jianhong;YANG Xiaodan(PLA 983 Hospital,Tianjin 300042,China)
出处
《河北医学》
CAS
2020年第7期1079-1084,共6页
Hebei Medicine
基金
天津市自然科学基金项目,(编号:18JCYBJC11604)。
关键词
后循环脑梗死
阿加曲班
血液流变学
神经功能缺损
日常生活活动能力
Posterior circulation cerebral infarction
Argatroban
Hemorheology
Nerve function defect
Activity of daily life
