目的 探討腦得生丸聯(lián)合阿加曲班治療急性腦梗死的臨床療效。方法 選取2021年1月至2022年12月淮南市新華醫(yī)療集團(tuán)新華醫(yī)院收治的106例急性腦梗死患者，按隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各53例。對(duì)照組靜脈滴注阿加曲班注射液，先以2.5 mg/h的速率持續(xù)靜脈內(nèi)泵入，連續(xù)用藥48 h；之后調(diào)整為10 mg/次，每次間隔12 h，每次給藥時(shí)間≥3 h，連續(xù)5 d；阿加曲班的總治療時(shí)間為7 d，其用藥結(jié)束后對(duì)患者繼續(xù)實(shí)施常規(guī)對(duì)癥治療。治療組在對(duì)照組治療基礎(chǔ)上口服腦得生丸，2 g/次，3次/d。兩組連續(xù)治療14 d。觀察兩組的臨床療效，比較治療前后神經(jīng)功能缺損情況、血栓彈力圖指標(biāo)及凝血功能指標(biāo)。結(jié)果 治療后，治療組總有效率是94.34%，顯著高于對(duì)照組的81.13%（P＜0.05）。治療后，兩組患者美國國立衛(wèi)生研究院卒中量表（NIHSS）評(píng)分均顯著低于同組治療前（P＜0.05），且治療組治療3、7、14 d后NIHSS評(píng)分均低于同期對(duì)照組（P＜0.05）。治療后，兩組患者凝固角（Angle）、凝血綜合指數(shù)（CI）、血栓最大強(qiáng)度（MA）均較治療前顯著降低，而凝血反應(yīng)時(shí)間（R）升高（P＜0.05）；治療后，治療組Angle、CI、MA均低于對(duì)照組，而R值高于對(duì)照組（P＜0.05）。治療后，兩組纖維蛋白原（FIB）、D-二聚體（D-D）、纖維蛋白降解產(chǎn)物（FDP）均較治療前顯著降低，而抗凝血酶Ⅲ（AT-Ⅲ）顯著升高（P＜0.05）；治療后，治療組FIB、D-D、FDP均低于對(duì)照組，而AT-Ⅲ高于對(duì)照組（P＜0.05）。結(jié)論 腦得生丸聯(lián)合阿加曲班治療急性腦梗死可取得較好的效果，可有效逆轉(zhuǎn)患者體內(nèi)高凝狀態(tài)、抑制血栓形成，對(duì)減輕神經(jīng)損傷具有十分重要的作用，且安全性好，值得臨床推廣應(yīng)用。

Objective To explore the clinical efficacy of Naodesheng Pills combined with agatroban in treatment of acute cerebral infarction. Methods A total of 106 patients with acute cerebral infarction admitted to Xinhua Hospital of Xinhua Medical Group in Huainan from January 2021 to December 2022 were selected and divided into control group and treatment group according to random number table method, with 53 patients in each group. Patients in the control group were iv administered with Argatroban Injection, the drug was injected intravenously at a rate of 2.5 mg/h for 48 h. Then the dosage was adjusted to 10 mg/time, each time at an interval of 12 h, each administration time ≥ 3 h, 5 d. The total treatment time of agatroban was 7 d, and the conventional symptomatic treatment was continued after the end of the treatment. Patients in the treatment group were po administered with Naodesheng Pills on the basis of the control group, 2 g/time, three times daily. The two groups were treated continuously for 14 d. The clinical effects of the two groups were observed, and the neurological defects, thromboelastogram indexes and coagulation function indexes were compared before and after treatment. Results After treatment, the total effective rate of treatment group was 94.34%, which was significantly higher than that of control group (81.13%, P < 0.05). After treatment, the National Institutes of Health Stroke Scale (NIHSS) scores of the two groups were significantly lower than before treatment (P < 0.05), and the NIHSS scores of treatment group were lower than those of control group after 3, 7 and 14 days of treatment (P < 0.05). After treatment, the coagulation Angle (Angle), coagulation composite index (CI) and maximum thrombus intensity (MA) in 2 groups were significantly decreased compared with before treatment, but coagulation reaction time (R) was increased (P < 0.05). After treatment, Angle, CI and MA in the treatment group were lower than those in control group, while R value was higher than that in control group (P < 0.05). After treatment, fibrinogen (FIB), D-dimer (D-D) and fibrin degradation product (FDP) in 2 groups were significantly decreased compared with before treatment, but antithrombin Ⅲ (AT-Ⅲ) was significantly increased (P < 0.05). After treatment, FIB, D-D and FDP in treatment group were lower than those in control group, while AT-Ⅲ was higher than that in the control group (P < 0.05). Conclusion Naodesheng Pills combined with agatroban can achieve better results in treatment of acute cerebral infarction, and can effectively reverse the hypercoagulable state in patients and inhibit thrombosis, has a very important role in alleviating nerve damage with good safety, which is worthy of clinical application.

R971

吳階平醫(yī)學(xué)基金會(huì)臨床科研專項(xiàng)資助項(xiàng)目（320.6750.2020-06-60）