目的 探討刺五加注射液聯(lián)合阿加曲班治療急性腦梗死的臨床療效。方法 選擇2021年5月—2023年5月在黃河三門峽醫(yī)院治療的98例急性腦梗死患者，按照隨機(jī)數(shù)字方法將患者分為對(duì)照組（49例）和治療組（49例）。對(duì)照組靜脈泵入阿加曲班注射液，60 mg加入到生理鹽水250 mL中，以5 mL/h的速度持續(xù)靜脈泵入48 h，隨后到第3天，將10 mg加入生理鹽水100 mL，靜脈滴注3 h，2次/d。治療組在對(duì)照組基礎(chǔ)上靜脈滴注刺五加注射液，60 mL加入生理鹽水250 mL，1次/d。兩組患者均治療14 d。觀察兩組患者臨床療效，比較治療前后兩組患者美國國立衛(wèi)生研究院卒中量表（NIHSS）、Barthel指數(shù)（BI）量表、簡(jiǎn)式Fugl-Meyer（FMA）評(píng)分，MRI-PWI相關(guān)參數(shù)腦血流量（CBF）、局部腦血容量（rCBV）、平均通過時(shí)間（MTT）和最大峰值時(shí)間（TTP）水平，炎癥因子白細(xì)胞介素-6（IL-6）、半乳糖凝集素-3（Gal-3）、高遷移率族蛋白B1（HMGB1）水平，神經(jīng)損傷相關(guān)指標(biāo)S100鈣結(jié)合蛋白β（S100β）、神經(jīng)元特異性烯醇化酶（NSE）、膠質(zhì)纖維酸性蛋白（GFAP）水平。結(jié)果 治療后，對(duì)照組總有效率為83.67%，治療組總有效率為95.92%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療后，兩組患者NIHSS評(píng)分較治療前有明顯下降，BI評(píng)分、FMA評(píng)分均較治療前明顯提高（P＜0.05），且治療組患者NIHSS評(píng)分、BI評(píng)分和FMA評(píng)分明顯好于對(duì)照組（P＜0.05）。治療后，兩組患者CBF、rCBV水平均較治療前明顯升高，MTT、TTP、IL-6、Gal-3、HMGB1、S100β、NSE、GFAP水平均較治療前明顯下降（P＜0.05），且治療組患者上述指標(biāo)改善更明顯（P＜0.05）。結(jié)論 刺五加注射液聯(lián)合阿加曲班治療急性腦梗死可發(fā)揮協(xié)同作用，提高臨床總有效率，能改善神經(jīng)功能缺損和腦部血流灌注水平，調(diào)節(jié)炎癥細(xì)胞因子的表達(dá)，減輕神經(jīng)細(xì)胞的損傷。

Objective To explore the clinical efficacy of Ciwujia Injection combined with agatroban in treatment of acute cerebral infarction. Methods A total of 98 patients with acute cerebral infarction treated in Sanmenxia Hospital of the Yellow River from May 2021 to May 2023 were selected and divided into control group (49 cases) and treatment group (49 cases) according to random number method. Patients in the control group were iv administered with Agatroban Injection, 60 mg added into normal saline 250 mL, continuously pumped at a rate of 5 mL/h for 48 h, and then added 10 mg to normal saline 100 mL on the 3rd day for 3 h, twice daily. Patients in the treatment group were iv administered with Ciwujia Injection on the basis of the control group, 60 mL added into normal saline 250 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical evaluation was evaluated, and the scores of NIHSS, BI and FMA, the levels of MRI-PWI related indexes CBF, rCBV, MTT and TTP, the levels of inflammatory factors IL-6, Gal-3 and HMGB1, the levels of nerve injury related indicators S100β, NSE and GFAP in two groups before and after treatment were compared. Results After treatment, the clinical effective rate was 83.67% in the control group and 95.92% in the treatment group, there was significant difference between the two groups (P < 0.05). After treatment, the NIHSS score in two groups was significantly lower than that before treatment, and the BI score and FMA score were significantly higher than those before treatment(P < 0.05), and these scores in the treatment group were significantly better than those of the control group (P < 0.05). After treatment, the levels of CBF and rCBV in two groups were significantly higher than those before treatment, while the levels of MTT, TTP, IL-6, Gal-3, HMGB1, S100β, NSE and GFAP were significantly decreased (P < 0.05), and the above-mentioned indexes were improved more significantly in the treatment group (P < 0.05). Conclusion The combination of Ciwujia Injection and Agatroban in the treatment of acute cerebral infarction can have a synergistic effect, improve overall clinical efficacy, which can improve the total clinical effective rate, improve the neurological impairment and the level of cerebral blood perfusion, regulate the expression of inflammatory cytokines, and reduce the injury of nerve cells.

R971

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目（LHGJ20200779）