目的 探討銀杏葉提取物注射液聯(lián)合阿加曲班治療急性腦梗死的臨床療效。方法 選取2020年1月—2021年12月定州市人民醫(yī)院收治的126例急性腦梗死患者，按照隨機(jī)數(shù)字表法將所有患者分為對照組和治療組，每組各63例。對照組給予阿加曲班注射液，開始以2.5 mg/h的速率持續(xù)靜脈泵入，連用2 d；隨后調(diào)整為10 mg/次，每日早晚各1次，每次靜脈滴注3 h，連續(xù)5 d。治療組在對照組基礎(chǔ)靜脈滴注銀杏葉提取物注射液，每次將20 mL加生理鹽水入250 mL中充分稀釋，1次/d。兩組療程均為14 d。觀察兩組的臨床療效，比較治療前后兩組相關(guān)量表[簡式Fugl-Meyer評定量表（FMA）、腦卒中自我效能問卷（SSEQ）、美國國立衛(wèi)生研究院卒中量表（NIHSS）]評分，凝血功能指標(biāo)[活化部分凝血活酶時間（APTT）、凝血酶原時間（PT）、纖維蛋白原（FIB）、D-二聚體（D-D）]，血液流變學(xué)參數(shù)[血漿黏度（PV）、紅細(xì)胞聚集指數(shù)（EAI）、紅細(xì)胞比容（HCT）、紅細(xì)胞沉降率（ESR）]及血清同型半胱氨酸（Hcy）、血管內(nèi)皮生長因子（VEGF）、可溶性CD40配體（sCD40L）水平。結(jié)果 治療后，治療組總有效率是95.24%，顯著高于對照組的84.13%（P＜0.05）。治療后，兩組FMA、SSEQ評分均顯著增加，NIHSS評分均顯著減少（P＜0.05）；治療后，各評分改善以治療組更顯著（P＜0.05）。治療后，兩組APTT、PT均顯著延長，血漿FIB、D-D水平均顯著降低（P＜0.05），均以治療組改善更顯著（P＜0.05）。治療后，兩組PV、EAI、HCT、ESR均較治療前顯著降低（P＜0.05），以治療組改善更顯著（P＜0.05）。治療后，兩組血清Hcy、sCD40L水平均顯著下降，血清VEGF水平均顯著上升（P＜0.05）；且治療后，治療組血清Hcy、VEGF、sCD40L水平改善均顯著優(yōu)于對照組（P＜0.05）。結(jié)論 銀杏葉提取物注射液聯(lián)合阿加曲班治療急性腦梗死有確切的臨床療效，在改善患者運(yùn)動功能、自我效能及神經(jīng)功能缺損方面均可獲得較為滿意的效果，且能安全有效地促進(jìn)凝血功能與血液流變性的恢復(fù)、減輕機(jī)體炎性損傷和內(nèi)皮損傷，值得臨床推廣應(yīng)用。

Objective To investigate the clinical efficacy of Extract of Ginkgo Biloba Leaves Injection combined with argatroban in treatment of acute cerebral infarction. Methods A total of 126 patients with acute cerebral infarction admitted to Dingzhou People’s Hospital from January 2020 to December 2021 were selected and divided into control group and treatment group according to random number table method, with 63 cases in each group. Patients in the control group were given Argatroban Injection, intravenously pumped at a rate of 2.5 mg/h for 2 d. Subsequently, the dosage was adjusted to 10 mg/time, once in the morning and once in the evening, for 3 h each time for consecutive 5 d. Patients in the treatment group were iv administered with Extract of Ginkgo Biloba Leaves Injection on the basis of the control group, added 20 mL into normal saline 250 mL for full dilution, once daily. The treatment course of both groups was 14 d. After treatment, the clinical efficacy was evaluated, the scores of related scales [Simple Fugl-Meyer Rating Scale (FMA), Stroke Self-efficacy Questionnaire (SSEQ), National Institutes of Health Stroke Scale (NIHSS)], coagulation function indexes [activation part, thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D)], hemorheological parameters [plasma viscosity (PV), erythrocyte aggregation index (EAI), hematocrit (HCT), erythrocyte sedimentation rate (ESR)], and serum homocysteine (Hcy), vascular endothelial growth factor (VEGF), soluble CD40 ligand (sCD40L) levels were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 95.24%, which was significantly higher than that of the control group (84.13%, P < 0.05). After treatment, FMA and SSEQ scores were significantly increased, while NIHSS scores were significantly decreased in both groups (P < 0.05). After treatment, the scores improved more significantly in the treatment group (P < 0.05). After treatment, APTT and PT in two groups were significantly prolonged, plasma FIB and D-D levels were significantly decreased (P < 0.05), and the improvement was more significant in the treatment group (P < 0.05). After treatment, PV, EAI, HCT, and ESR in two groups were significantly decreased compared with before treatment (P < 0.05), and the improvement was more significant in the treatment group (P < 0.05). After treatment, serum Hcy and sCD40L levels were significantly decreased, and serum VEGF levels were significantly increased in two groups (P < 0.05). After treatment, the improvement of serum Hcy, VEGF and sCD40L levels in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion Extract of Ginkgo Biloba Leaves Injection combined with argatroban has a definite curative effect in treatment of acute cerebral infarction, and can achieve satisfactory results in improving motor function, self-efficacy and neurological deficit of patients, and can safely and effectively promote the recovery of blood coagulation function, hemological rheology, and alleviate the inflammatory injury and endothelial injury, which is worthy of clinical application.

R971

河北省衛(wèi)生廳科研計劃項目（20191745）