目的 探討銀杏內(nèi)酯注射液聯(lián)合阿加曲班治療急性腦梗死的臨床效果。方法 選取2020年1月—2021年10月江陰市中醫(yī)院收治的82例急性腦梗死患者，以隨機(jī)數(shù)字表法將患者平均分為對(duì)照組（41例）和治療組（41例）。對(duì)照組靜脈滴注阿加曲班注射液，第1～2天劑量為60mg/d，溶入500mL生理鹽水，輸注24h；第3～7天劑量為20mg/次，溶入250mL生理鹽水，1次/d，3h/次。在對(duì)照組基礎(chǔ)上，治療組患者靜脈滴注銀杏內(nèi)酯注射液，10mL/次，溶入250mL生理鹽水，1次/d，滴注速度控制在40～60滴/min。兩組均連續(xù)治療14d。觀察兩組患者臨床療效，比較治療前后兩組患者NIHSS評(píng)分，高凝指標(biāo)血漿纖維蛋白原（FIB）、D-二聚體（D-D）、血小板最大聚集率（MAR）、血栓彈力圖參數(shù)凝血反應(yīng)時(shí)間（R值）、凝固時(shí)間（K值）、α角、最大振幅（MA值）、凝血綜合指數(shù)（CI值），血清神經(jīng)元特異性烯醇化酶（NSE）和S100β蛋白、內(nèi)皮素-1（ET-1）、可溶性細(xì)胞間黏附分子1（sICAM-1）和高遷移率族蛋白B1（HMGB1）水平。結(jié)果 治療后，治療組臨床總有效率（92.68%）較對(duì)照組（75.61%）顯著提高（P<0.05）。與治療前對(duì)比，治療后兩組NIHSS評(píng)分和血漿FIB、D-D水平及MAR均顯著降低（P<0.05），但均以治療組的下降更顯著（P<0.05）。相較治療前，治療后兩組血栓彈力圖參數(shù)R值、K值均顯著增加，而α角、MA值和CI值則均顯著減小（P<0.05），但均以治療組的改善更顯著（P<0.05）。治療后，兩組血清NSE、S100β蛋白、ET-1、sICAM-1及HMGB1水平均較治療前顯著下降（P<0.05），且治療后治療組顯著低于對(duì)照組（P<0.05）。結(jié)論 銀杏內(nèi)酯注射液聯(lián)合阿加曲班治療急性腦梗死能明顯減輕患者神經(jīng)功能損傷，糾正血液高凝狀態(tài)和血管內(nèi)皮功能紊亂，降低機(jī)體炎癥反應(yīng)，促進(jìn)神經(jīng)功能恢復(fù)，且安全性較好。

Objective To investigate the clinical effect of Ginkgolide Injection combined with argatroban in treatment of acute cerebral infarction. Methods Patients (82 cases) with acute cerebral infarction in Jiangyin Hospital of Traditional Chinese Medicine from January 2020 to October 2021 were randomly divided into control (41 cases) and treatment (41 cases) group. Patients in the control group were iv administered with Argatroban Injection, the dose was 60 mg/d on the 1 — 2 d, drug was dissolved in 500 mL saline for 24 h, and 20 mg/ on the 3 — 7 d, drug was dissolved in 250 mL saline once daily, 3 h/time. Patients in the treatment group were iv administered with Ginkgolide Injection on the basis of the control group, 10 mL/time dissolved in 250 mL saline, once daily, the drip speed was controlled at 40 — 60 drops/min. Patients in two groups were treated for 14 d. After treatment, the clinical evaluation was evaluated, the NIHSS scores, FIB, the levels of plasma D-D, MAR, and TEG, the levels of serum NSE, S100β, ET-1, sICAM-1 and HMGB1 in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group (92.68%) was significantly higher than that of the control group (75.61) (P < 0.05). The NIHSS score and the levels of plasma FIB, D-D and MAR in two groups were significantly decreased after treatment (P < 0.05), but the decrease in the treatment group was more significant (P < 0.05). Compared with those before treatment, the thromboelastogram parameters R and K in two groups were significantly increased, while the α angle, MA value and CI value significantly decreased (P< 0.05) ,but the improvement in the treatment group was more significant (P < 0.05). After treatment, the levels of serum NSE, S100 β protein, ET-1, sICAM-1 and HMGB1 in two groups were significantly lower than those before treatment, and which in the treatment group were significantly lower than those in the control group after treatment (P < 0.05). Conclusion Ginkgolide Injection combined with agatroban in the treatment of acute cerebral infarction can significantly reduce neurological damage, correct blood hypercoagulable state and vascular endothelial dysfunction, reduce inflammatory reaction and promote the recovery of neurological function with good safety.

R971

江陰市衛(wèi)生健康委面上科研項(xiàng)目（S202006）