Objective To compare the effect of argatroban injection and low molecular weight heparin injection in treating acute cerebral infarction.Methods Totally 180 patients with acute cerebral infarction from December 2013 to March 2015 were randomly divided into argatroban group and low molecular weight heparin group (90 cases in each group).Both group received 14 days of conventional therapy.Argatroban group was additionally given argatroban as followed:60 mg diluted into 120 ml 0.9％ sodium chloride injection,continuous infusion with pump for 24 h on the first 2 days;10 mg diluted into 20 ml 0.9％ sodium chloride injection,continuous infusion with pump for 3 h,2 times/d on the next 5 days.Low molecular weight heparin group was additionally given subcutaneous injection of low molecular weight heparin injection (6 000 IU/time,2 times/d) for 10 days.The blood coagulation function [thrombin time (TT),prothrombin time (PT),activated partial clotting enzyme live time (APTT),fibrinogen (FIB) and platelet count (PLT)],the National Institutes of Health Stroke Scale (NIHSS) score,the Barthel index score,clinical efficacy and adverse reactions were compared between groups.Results Before treatment,blood coagulation function were not significantly different between groups (P ＞ 0.05).After 7 d treatment,TT and APTT in low molecular weight heparin were significantly higher than those before treatment [(20.7 ± 1.5) s vs (16.7 ± 1.5) s,(37 ±4) s vs (30 ±4) s],PLT was significantly lower than that before treatment [(164 ± 40) × 109/L vs (190 ± 60) × 109/L] (P ＜ 0.05).The blood coagulation function indices were significantly different between groups (P ＞ 0.05).Before treatment,the NIHSS score and the Barthel index score were not significantly different (P ＞ 0.05);14 d after treatment,the NIHSS score was significantly lower than that before treatment in argatroban group and low molecular weight heparin group [(7 ± 4) scores vs (21 ±4) scores,(12±5) scores vs (21 ±4) scores],and was more lower in argatroban group (P ＜0.05);14 d after treatment,the Barthel index was significantly lower than that before treatment in argatroban group and low molecular weight heparin group [(78 ± 11) scores vs (44 ± 10) scores,(66 ± 10) scores vs (45 ± 10) scores],and was more higher in argatroban group (P ＜0.05).In argatroban group,the effective rate was significantly higher than that in low molecular heparin calcium group [96.7％ (87/90) vs 81.1％ (73/90)];the incidence of adverse reactions was significantly lower than that in low molecular heparin calcium group [1.1％ (1/90) vs 15.6％ (14/90)] (P ＜0.05).Conclusion Argatroban can significantly improve the disturbance of consciousness and neural functions in patients with acute cerebral infarction,with better clinical adaptability and safety compared with low molecular heparin calcium.%目的 比较阿加曲班和低分子肝素钙治疗急性脑梗死的疗效.方法 选取2013年12月至2015年3月河南省南阳市第二人民医院神经内科收治的急性脑梗死患者180例作为研究对象,采用随机数字表法将患者分为阿加曲班组和低分子肝素钙组,各90例.阿加曲班组在常规治疗的基础上给予阿加曲班注射液治疗,第1～2天为60 mg阿加曲班溶入120 ml 0.9％氯化钠注射液,持续不间断24 h泵注给药,第3天起,以10 mg阿加曲班溶入20 ml 0.9％氯化钠注射液静脉泵注3h,2次/d,连续治疗7d,后继续常规治疗.低分子肝素钙组在常规治疗的基础上给予低分子肝素钙注射液皮下注射,6 000 IU/次,1次/12 h,连续10 d.2组均治疗14 d后观察疗效.比较2组患者治疗前后凝血功能[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)含量和血小板计数(PLT)]变化、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数评分改善情况、疗效和不良反应发生情况.结果 治疗前,2组患者凝血功能指标差异均无统计学意义(均P＞0.05).治疗7d后,低分子肝素钙组TT、APTT明显长于治疗前[(20.7±1.5)s比(16.7±1.5)s,(37±4)s比(30±4)s],PLT明显低于治疗前[(164±40)×109/L比(190 ±60)×109/L],差异均有统计学意义(均P＜0.05).2组治疗后各时点凝血功能指标比较,差异均无统计学意义(均P＞0.05).2组治疗前NIHSS评分、Barthel指数评分比较,差异均无统计学意义(均P ＞0.05).治疗14 d后,阿加曲班组和低分子肝素钙组NIHSS评分均明显低于治疗前[(7±4)分比(21±4)分,(12±5)分比(21±4)分],且阿加曲班组低于低分子肝素钙组;Barthel指数评分均明显高于治疗前[(78±11)分比(44±10)分,(66±10)分比(45±10)分],且阿加曲班组高于低分子肝素钙组,差异均有统计学意义(均P ＜0.05).阿加曲班组总有效率明显高于低分子肝素钙组[96.7％(87/90)比81.1％ (73/90)],不良反应发生率明显低于低分子肝素钙组[1.1％ (1/90)比15.6％(14/90)],差异均有统计学意义(均P＜0.05).结论 阿加曲班较低分子肝素钙对脑梗死患者的意识障碍和神经症状改善更明显,在临床上具有更强的适应性和安全性.
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