目的 探討華法林鈉片聯(lián)合替格瑞洛片治療急性心肌梗死的臨床療效。方法 選擇2019年4月-2020年4月在河南省中醫(yī)藥研究院附屬醫(yī)院治療的急性心肌梗死患者90例，根據(jù)住院號(hào)分為對照組（45例）和治療組（45例）。對照組口服替格瑞洛片，起始劑量180 mg/次，此后90 mg/次，2次/d。治療組在對照組基礎(chǔ)上口服華法林鈉片，第1~3天3~4 mg，3 d后可給維持量2.5~5 mg/d。兩組患者均經(jīng)2周治療。觀察兩組患者臨床療效，同時(shí)比較治療前后兩組患者左心室射血分?jǐn)?shù)（LVEF）、左心室收縮末期內(nèi)徑（LVESD）、左心室收縮末期容積（LVESV）、左室舒張末期內(nèi)經(jīng)（LVEDD）、血管生長因子B（VEGF-B）、可溶性細(xì)胞間黏附分子-1（sICAM-1）、半乳凝素-3（Gal-3）、基質(zhì)金屬蛋白酶-9（MMP-9）、內(nèi)皮素（ET）和一氧化氮（NO）水平，及QRS積分和心肌梗死面積。結(jié)果 治療后，對照組和治療組臨床有效率分別為80.00%和95.56%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組LVEDD、LVESV和LVESD明顯下降（P<0.05），而LVEF明顯升高（P<0.05），且治療組心功能指標(biāo)明顯好于對照組（P<0.05）。治療后，兩組Gal-3明顯升高（P<0.05），而MMP-9明顯降低（P<0.05），且治療組Gal-3和MMP-9水平明顯好于對照組（P<0.05）。治療后，兩組患者ET和sICAM-1明顯降低（P<0.05），而VEGF-B和NO明顯升高（P<0.05），且治療組水平明顯好于對照組（P<0.05）。治療后，兩組QRS積分和心肌梗死面積明顯減?。?i>P<0.05），且治療組明顯小于對照組（P<0.05）。結(jié)論 華法林鈉片聯(lián)合替格瑞洛片治療急性心肌梗死可有效改善患者心功能，改善心肌重構(gòu)，促進(jìn)血管內(nèi)皮細(xì)胞功能改善，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the clinical effect of warfarin combined with tegrilol in treatment of acute myocardial infarction. Methods Patients (90 cases) with acute myocardial infarction in the Affiliated Hospital of Henan Academy of Chinese Medicine from April 2019 to April 2020 were divided into control (45 cases) and treatment (45 cases) groups based on hospitalization number. Patients in the control group were po administered with Ticagrelor Tablets, the initial dose was 180 mg/time, then 90 mg/time, twice daily. Patients in the treatment group were po administered with Warfarin Sodium Tablets on the basis of the control group, 3-4 mg for the first to third day, and then the maintain the dose was 2.5-5 mg/d after 3 days. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the levels of LVEDD, LVESV, LVESD, LVEF, Gal-3, MMP-9, ET, sICAM-1, VEGF-B and NO, the QRS scores and myocardial infarction area in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 80.00% and 95.56%, respectively, and there were differences between two groups (P<0.05). After treatment, the LVEDD, LVESV, and LVESD in two groups were significantly decreased (P<0.05), but LVEF were significantly increased (P<0.05), and these cardiac function indexes in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the Gal-3 in two groups was significantly increased (P<0.05), but MMP-9 was significantly decreased (P<0.05), and the Gal-3 and MMP-9 in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the ET and sICAM-1 in two groups were significantly decreased (P<0.05), but the VEGF-B and NO were significantly increased (P<0.05), and these vascular endothelial cytokines levels in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the QRS scores and myocardial infarction area in two groups were significantly reduced (P<0.05), and which in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion warfarin combined with tegrilol in treatment of acute myocardial infarction can effectively improve the cardiac function, myocardial remodeling, and improve the function of vascular endothelial cells, which has a certain clinical application value.

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