2019 年第 12 期 第 14 卷

阿加曲班对心房颤动合并脑梗死患者神经功能和血管内皮功能及凝血功能的影响

Effect of argatroban on neurological function, vascular endothelial function and coagulation function in patients with atrial fibrillation and cerebral embolism

作者：庄丽丽车浩惠新晨

英文作者：

单位：221009江苏省徐州市中心医院神经内科

英文单位：

关键词：心房颤动；脑梗死；阿加曲班；神经功能；同型半胱氨酸；凝血功能

英文关键词：

• 摘要：

• 【摘要】目的    探究阿加曲班对心房颤动合并脑梗死患者神经功能、血管内皮功能及凝血功能的影响。方法    选取2016年1月至2019年2月在江苏省徐州市中心医院神经内科进行治疗的90例心房颤动合并脑梗死患者，按照随机数字表法分为对照组和观察组，各45例。对照组采用静脉泵注0.9%氯化钠注射液、口服达比加群酯胶囊治疗。观察组采用静脉泵注阿加曲班、口服达比加群酯胶囊治疗。比较2组神经功能、血管内皮功能、凝血功能和疗效。结果    与治疗前比较，治疗第8天和第30天，2组患者美国国立卫生研究院卒中量表评分、血清内皮素1和同型半胱氨酸水平均降低，且观察组低于对照组［第8天：（9.2±1.3）分比（15.1±3.2）分、（70±6）ng/L比（76±7）ng/L、（13±3）μmol/L比（18±4）μmol/L，第30天：（8.5±1.0）分比（14.4±3.5）分、（72±7）ng/L比（78±8）ng/L、（13±3）μmol/L比（19±4）μmol/L］；2组患者Barthel指数、血清一氧化氮水平均升高，且观察组高于对照组［第8天：（77±8）分比（60±6）分、（62±6）μmol/L比（55±5）μmol/L，第30天：（81±8）分比（63±6）分、（58±6）μmol/L比（52±5）μmol/L］，差异均有统计学意义（均P＜0.05）。与治疗前比较，治疗第8天，2组患者的凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）均升高，且观察组高于对照组［（45.0±7.8）s比（16.6±3.2）s、（45±8）s比（32±6）s、（21.7±4.1）s比（14.3±3.8）s］；治疗第30天，观察组TT、APTT、PT高于治疗前和对照组，差异均有统计学意义（均P＜0.05）。观察组的总有效率明显高于对照组［88.9%（40/45）比71.1%（32/45）］，差异有统计学意义（P＝0.035）。结论    阿加曲班具有良好的抗凝效果，能够改善神经功能和血管内皮功能，是治疗心房颤动合并脑梗死的有效手段。

• 【Abstract】Objective    To explore the effect of argatroban on neurological function, vascular endothelial function and coagulation function in patients with atrial fibrillation and cerebral embolism. Methods    Ninety patients with atrial fibrillation and cerebral embolism admitted to Xuzhou Central Hospital, Jiangsu Province from January 2016 to February 2019 were randomly divided into observation group and control group, with 45 cases in each group. The control group was treated with 0.9% sodium chloride injection and dabigatran etexilate capsules. The observation group had intravenous administration of argatroban and took dabigatran etexilate capsules. Neurological function, vascular endothelial function, coagulation function and the overall efficacy were analyzed. Results    At 8 and 30 days after treatment, score of National Institute of Health Stroke Scale(NIHSS), levels of serum endothelin-1(ET-1) and homocysteine(Hcy) significantly decreased in both groups; NIHSS score, ET-1 and Hcy levels in observation group were lower than those in control group［8 d：（9.2±1.3） vs （15.1±3.2）, （70±6）ng/L vs （76±7）ng/L, （13±3）μmol/L vs （18±4）μmol/L; 30 d：（8.5±1.0） vs （14.4±3.5）, （72±7）ng/L vs （78±8）ng/L, （13±3）μmol/L vs （19±4）μmol/L］(all P＜0.05); Barthel score and serum nitric oxide level significantly increased in both groups and they were higher in observation group than those in control group［8 d：（77±8） vs （60±6）, （62±6）μmol/L vs （55±5）μmol/L; 30 d：（81±8） vs （63±6）, （58±6）μmol/L vs （52±5）μmol/L］（all P＜0.05）. At 8 days after treatment, thrombin time（TT）, activated partial thromboplastin time（APTT） and prothrombin time（PT） significantly increased in both groups; the indexes in observation group were higher than those in control group［（45.0±7.8）s vs （16.6±3.2）s, （45±8）s vs （32±6）s, （21.7±4.1）s vs （14.3±3.8）s］（all P＜0.05）. TT, APTT and PT at 30 days after treatment in observation group were higher than those before treatment and those in control group（all P＜0.05）. The total effective rate in observation group was significantly higher than that in control group［88.9%（40/45） vs 71.1%（32/45）］（P＝0.035）. Conclusions    Argatroban has good anticoagulant effect and can improve neurological and vascular endothelial function. It is an effective method to treat atrial fibrillation complicated with cerebral embolism.