目的 探讨刺五加注射液联合阿加曲班治疗急性脑梗死的临床疗效。方法 选择2021年5月—2023年5月在黄河三门峡医院治疗的98例急性脑梗死患者，按照随机数字方法将患者分为对照组（49例）和治疗组（49例）。对照组静脉泵入阿加曲班注射液，60 mg加入到生理盐水250 mL中，以5 mL/h的速度持续静脉泵入48 h，随后到第3天，将10 mg加入生理盐水100 mL，静脉滴注3 h，2次/d。治疗组在对照组基础上静脉滴注刺五加注射液，60 mL加入生理盐水250 mL，1次/d。两组患者均治疗14 d。观察两组患者临床疗效，比较治疗前后两组患者美国国立卫生研究院卒中量表（NIHSS）、Barthel指数（BI）量表、简式Fugl-Meyer（FMA）评分，MRI-PWI相关参数脑血流量（CBF）、局部脑血容量（rCBV）、平均通过时间（MTT）和最大峰值时间（TTP）水平，炎症因子白细胞介素-6（IL-6）、半乳糖凝集素-3（Gal-3）、高迁移率族蛋白B1（HMGB1）水平，神经损伤相关指标S100钙结合蛋白β（S100β）、神经元特异性烯醇化酶（NSE）、胶质纤维酸性蛋白（GFAP）水平。结果 治疗后，对照组总有效率为83.67%，治疗组总有效率为95.92%，两组比较差异具有统计学意义（P＜0.05）。治疗后，两组患者NIHSS评分较治疗前有明显下降，BI评分、FMA评分均较治疗前明显提高（P＜0.05），且治疗组患者NIHSS评分、BI评分和FMA评分明显好于对照组（P＜0.05）。治疗后，两组患者CBF、rCBV水平均较治疗前明显升高，MTT、TTP、IL-6、Gal-3、HMGB1、S100β、NSE、GFAP水平均较治疗前明显下降（P＜0.05），且治疗组患者上述指标改善更明显（P＜0.05）。结论 刺五加注射液联合阿加曲班治疗急性脑梗死可发挥协同作用，提高临床总有效率，能改善神经功能缺损和脑部血流灌注水平，调节炎症细胞因子的表达，减轻神经细胞的损伤。

Objective To explore the clinical efficacy of Ciwujia Injection combined with agatroban in treatment of acute cerebral infarction. Methods A total of 98 patients with acute cerebral infarction treated in Sanmenxia Hospital of the Yellow River from May 2021 to May 2023 were selected and divided into control group (49 cases) and treatment group (49 cases) according to random number method. Patients in the control group were iv administered with Agatroban Injection, 60 mg added into normal saline 250 mL, continuously pumped at a rate of 5 mL/h for 48 h, and then added 10 mg to normal saline 100 mL on the 3rd day for 3 h, twice daily. Patients in the treatment group were iv administered with Ciwujia Injection on the basis of the control group, 60 mL added into normal saline 250 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical evaluation was evaluated, and the scores of NIHSS, BI and FMA, the levels of MRI-PWI related indexes CBF, rCBV, MTT and TTP, the levels of inflammatory factors IL-6, Gal-3 and HMGB1, the levels of nerve injury related indicators S100β, NSE and GFAP in two groups before and after treatment were compared. Results After treatment, the clinical effective rate was 83.67% in the control group and 95.92% in the treatment group, there was significant difference between the two groups (P < 0.05). After treatment, the NIHSS score in two groups was significantly lower than that before treatment, and the BI score and FMA score were significantly higher than those before treatment(P < 0.05), and these scores in the treatment group were significantly better than those of the control group (P < 0.05). After treatment, the levels of CBF and rCBV in two groups were significantly higher than those before treatment, while the levels of MTT, TTP, IL-6, Gal-3, HMGB1, S100β, NSE and GFAP were significantly decreased (P < 0.05), and the above-mentioned indexes were improved more significantly in the treatment group (P < 0.05). Conclusion The combination of Ciwujia Injection and Agatroban in the treatment of acute cerebral infarction can have a synergistic effect, improve overall clinical efficacy, which can improve the total clinical effective rate, improve the neurological impairment and the level of cerebral blood perfusion, regulate the expression of inflammatory cytokines, and reduce the injury of nerve cells.

R971

河南省医学科技攻关计划项目（LHGJ20200779）