biuret中国疗养医学2020年第29卷第12期Chin J Convalescent Med，Dec.2020，Vol.29，No.12
·临床论著·阿加曲班对大动脉粥样硬化性脑梗死动脉-动脉栓塞
vague发病机制患者的疗效
张卓up to
eastman kodak
【摘要】目的探讨阿司匹林联合阿加曲班、氯吡格雷对中国缺血性卒中亚型(Chine ischemic stroke
sub-classification，CISS)分型为大动脉粥样硬化(LAA)且发病机制为动脉-动脉栓塞患者的临床疗效。方法对
2019年1月至2020年1月在天津市环湖医院神经康复科住院的CISS分型为LAA且发病机制为动脉-动脉栓塞的
脑梗死患者进行回顾性分析。依据住院时治疗方案分为观察组(阿司匹林联合阿加曲班)和对照组(阿司匹林
联合氯吡格雷)，比较两组入院时NIHSS评分、出院时NIHSS评分、入院时Barthel指数(BI)评分、出院时BI评分、
住院天数等，分析两种治疗方案对此类患者的疗效差异。结果两组间比较，入院时NIHSS评分及BI评分差异
均无统计学意义(＝0.12，＝0.11)；出院时NIHSS评分及BI评分差异均无统计学意义(＝0.13，＝0.11)。两
组内出院时与入院时比较，NIHSS评分及BI评分差异均有高度统计学意义(＜0.001)。两组总有效率差异无统
计学意义(＝0.11)。但对有效率进行进一步分析发现观察组基本治愈率显著高于对照组，差异有统计学意义
(＝0.04)。观察组平均住院时间少于对照组，差异有统计学意义(＝0.02)。结论阿加曲班联合阿司匹林对
CISS分型为LAA且发病机制为动脉-动脉栓塞的脑梗死患者有效，且疗效可能更好，但总有效率并不优于阿司
匹林联合氯吡格雷方案。
【关键词】脑梗死；阿加曲班；大动脉粥样硬化；中国缺血性卒中亚型
中国海洋大学研究生【Abstract】Objective To explore the clinical effect of Aspirin combined with Argatroban and Clopidogrel in pa-
tients with Chine ischemic stroke sub-classification(CISS)of large artery atherosclerosis(LAA)and the pathogenesis四化管理>pof
of artery-to-artery embolism.Methods Retrospective analysis was conducted on cerebral infarction patients with LAA
type and artery-artery embolization pathogenesis of CISS hospitalized in the Department of Neurological Rehabilitation
of Tianjin Huanhu Hospital from January2019to January2020.According to the treatment plans during hospitaliza-
tion，they were divided into an obrvation group(Aspirin combined with Argatroban)and a control group(Aspirin
combined with Clopidogrel).NIHSS scores and BI scores on admission and discharge，and the hospitalization days in
the two groups were compared to analyze the differences of curative effects between the two treatment plans for such patients.Results There was no statistically significant difference between the two groups in NIHSS score and BI
交朋友的方法>英语四级贴吧
score at admission(＝0.12，＝0.11).There was no statistically significant difference between NIHSS score and BI
score at discharge(0.13，＝0.11).The NIHSS score and BI score were significantly different between the two
groups when discharged from hospital and when admitted to hospital(＜0.001).There was no statistically significant difference in total effective rate between the two groups(＝0.11).However，further analysis of the effective rate
showed that the basic cure rate of the obrvation group was significantly higher than that of the control group，with a statistically significant difference(＝0.04).The average length of hospitalization in the obrvation group was less
than that in the control group，and the difference was statistically significant(＝0.02).Conclusion Argatroban com-
bined with Aspirin is effective in patients with CISS of LAA and the pathogenesis of artery-to-artery embolism，and
the effect is probably better，but the total effective rate is not superior to that of Aspirin combined with Clopidogrel.
【Key words】Cerebral infarction；Argatroban；Large artery atherosclerosis；Chine ischemic stroke sub-classification
目前对缺血性脑卒中患者倡导进行依据病因及发病机制的个体化治疗和二级预防，以精准改善患者急性期神经功能缺损及预后。国际上目前应用较广泛的缺血性脑卒中的病因学分类标准是1993年提出的Org10172急性卒中治疗试验(Trial of Org10172in acute stroke treatment，TOAST)分型。但由于TOAST分型没有对大动脉粥样硬化(large artery atherosclerosis，LAA)的发病机制进行分析，中国学者于2011年提出的中国缺血性卒中亚型(Chine ischemic stroke sub-classification，CISS)分型标准，对LAA型脑梗死的发病机制进行了定义。目前在CISS分型为LAA且发病机制为动脉-动脉栓塞的患者治疗方面，包括静脉溶栓、抗血小板聚集、抗凝、降纤、改善循环等，但是静脉溶栓治疗仅适合时间窗以内的患者，传统的抗凝治疗如低分子肝素等虽可能对缺血性脑卒中患者有效，但出血风险较高，最终预后尚不明确，因此并不推荐常规使用。近年来，许多研究[1-6]报道了阿加曲班作为一种直接凝血酶抑制剂在急性脑梗死及血栓傲骨贤妻 第五季
文章编号：1005-619X(2020)12-1233-04
DOI编码：10.13517/jkim.2020.12.001
作者单位：330350天津市环湖医院神经康复科
1233··
