目的 探讨注射用七叶皂苷钠联合替罗非班治疗急性脑梗死的临床疗效。方法 选取2018年3月—2021年12月太和县人民医院收治的94例急性脑梗死患者，按随机数字表法将所有患者分为对照组和治疗组，每组各47例。对照组静脉滴注盐酸替罗非班氯化钠注射液，前30 min滴注速率是0.4 μg/（kg·min），维持滴速是0.1 μg/（kg·min）。治疗组在对照组基础上静脉滴注注射用七叶皂苷钠治疗，10 mg加入0.9%氯化钠注射液250 mL中充分溶解、稀释，2次/d。连续治疗14 d后观察两组临床疗效。比较治疗前后两组相关量表评分、洼田饮水试验评级、血浆纤维蛋白原（FIB）、D-二聚体（D-D）水平，血小板最大聚集率（MAR）、血清C反应蛋白（CRP）水平及外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）。结果 治疗后，治疗组总有效率是93.6%，较对照组78.7%显著升高（P<0.05）。治疗后，两组患者NIHSS评分较治疗前均显著降低（P<0.05），且治疗后治疗组各时点NIHSS评分均低于对照组（P<0.05）。治疗后，两组洼田饮水试验评级和mRS评分均显著降低，MBI评分均显著增加（P<0.05）；且均以治疗组改善更显著（P<0.05）。治疗后，两组血浆FIB、D-D水平、MAR均显著降低（P<0.05），且治疗组血浆FIB、D-D水平和MAR均低于对照组（P<0.05）。治疗后，两组血清CRP水平和外周血NLR、PLR均较治疗前显著下降（P<0.05）；且治疗后，治疗组血清CRP水平和外周血NLR、PLR均显著低于对照组（P<0.05）。结论 注射用七叶皂苷钠联合替罗非班治疗急性脑梗死的整体疗效确切，能有效抑制血栓形成、减轻机体炎性损伤，促进患者神经功能、吞咽功能和日常生活能力的恢复，且安全性较好。

Objective To investigate the clinical efficacy of Sodium Aescinate for injection combined with tirofiban in treatment of acute cerebral infarction. Methods A total of 94 patients with acute cerebral infarction admitted to Taihe County People's Hospital from March 2018 to December 2021 were selected and divided into control group and treatment group according to the random number table method, with 47 cases in each group. Patients in the control group were iv administered with Tirofiban Hydrochloride and Sodium Chloride Injection, the infusion rate was 0.4 μg/(kg∙min) for the first 30 minutes and 0.1 μg/(kg∙min) was maintained. Patients in the treatment group were iv administered with Sodium Aescinate for injection on the basis of the control group, 10 mg was added into 0.9% sodium chloride injection 250 mL to fully dissolve and dilute, twice daily. The clinical efficacy of the two groups was observed after 14 d of continuous treatment. Before and after treatment, the National Institutes of Health Stroke Scale (NIHSS) score, Kubota drinking test score, Modified Rankin Scale (mRS) score, Modified Barthel Index (MBI) score, plasma fibrinogen (FIB), D-Dimer (D-D) level, platelet maximum aggregation rate (MAR), serum C-reactive protein (CRP) level, and peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) of the two groups were compared. Results After treatment, the total effective rate of the treatment group was 93.6%, which was significantly higher than 78.7% of the control group (P < 0.05). After treatment, the NIHSS score of the two groups was significantly lower than that before treatment (P < 0.05), and the NIHSS score of the treatment group was lower than that of the control group at each time point after treatment (P < 0.05). After treatment, the drinking water test rating and mRS score of the two groups were significantly decreased, and the MBI score was significantly increased (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, the plasma levels of FIB, D-D and MAR in the two groups were significantly decreased (P < 0.05), and the plasma levels of FIB, D-D and MAR in the treatment group were lower than those in the control group (P < 0.05). After treatment, the levels of serum CRP, peripheral blood NLR and PLR in the two groups were significantly decreased compared with those before treatment (P < 0.05). After treatment, the serum CRP level, peripheral blood NLR and PLR in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Sodium Aescinate for injection combined with tirofiban has a definite overall efficacy in treatment of acute cerebral infarction, and can effectively inhibit thrombosis, reduce inflammatory injury, promote the recovery of neurological function, swallowing function and daily living ability of patients, which has good safety.

R971

阜阳市自筹经费科技计划项目（FK202081805）