目的 观察阿加曲班联合长春西汀治疗急性脑梗死临床疗效和安全性。方法 选取2016年1月-2018年4月合肥市第三人民医院收治的急性脑梗死患者90例，随机分为对照组（45例）和治疗组（45例）。对照组静脉滴注长春西汀注射液，30 mg/次，1次/d。治疗组在对照组基础上静脉滴注阿加曲班注射液，20 mg加入生理盐水250 mL，1次/d，或10 mg微量泵缓慢泵入，2次/d，两组患者均连续治疗14 d。观察两组患者临床疗效，同时比较治疗前后两组患者NIHSS、BI指数、mRS评分、血液流变学指标及血清和肽素（CPP）、胰岛素样生长因子1（IGF-1）、N端前脑钠肽（NT-proBNP）和亲和素A（CyPA）值。结果 治疗后，对照组总有效率为84.44%，显著低于治疗组的95.56%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组NIHSS评分和mRS评分明显下降（P<0.05），BI评分指数显著升高（P<0.05），与对照组相比，治疗后治疗组患者NIHSS、BI指数、mRS评分改善更显著（P<0.05、0.01）。治疗后，两组患者血浆黏度（PV）、红细胞压积（HCT）、全血黏度（WBV）和纤维蛋白原（FIB）均明显降低（P<0.05），且治疗组PV、HCT和WBV比对照组降低更明显（P<0.05）。治疗后，两组患者CPP、CyPA和NT-proBNP水平均显著降低（P<0.05、0.01），IGF-1水平显著升高（P<0.05、0.01）；且治疗后治疗组上述指标改善更明显（P<0.05、0.01）。结论 阿加曲班联合长春西汀治疗急性脑梗死临床疗效确切，能显著促进患者神经功能恢复，改善血液流变学指标，提高日常活动能力。

Objective To observe the clinical efficacy and safety of argatroban combined with vinpocetine in treatment of acute cerebral infarction.Methods Patients (90 cases) with acute cerebral infarction in the Third People's Hospital of Hefei from January 2016 to April 2018 were randomly divided into control (45 cases) and treatment (45 cases) groups. Patients in the control group were iv administered with Vinpocetine Injection, 30 mg/time, once daily. Patients in the treatment group were iv administered with Argatroban Injection on the basis of the control group, 20 mg added into normal saline 250 mL, once daily, or 10 mg was pumped slowly with micro pump, twice daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the NIHSS, BI indexes, mRS scores, hemorhrological indexes, and serum CPP, IGF-1, NT-proBNP, and CyPA value in two groups before and after treatment were compared.Results After treatment, the clinical efficacy in the control group was 84.44%, which was significantly lower than 95.56% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the NIHSS and mRS in two groups were significantly decreased (P<0.05), but BI indexes were significantly increased (P<0.05), and NIHSS, BI indexes, mRS scores in the treatment group were significantly better than those in the control group (P<0.05, 0.01). After treatment, the PV, HCT, WBV and FIB levels in two groups were significantly decreased (P<0.05), and PV, HCT and WBV levels in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the CPP, CyPA and NT-proBNP levels in two groups were significantly decreased (P<0.05, 0.01), but IGF-1 levels were significantly increased (P<0.05, 0.01), and these indexes in the treatment group were significantly better than those in the control group (P<0.05, 0.01).Conclusion Argatroban combined with vinpocetine has definite clinical effect in treatment of acute cerebral infarction, can promoted the recovery of nerve function, improved the hemorheology indexes, and enhanced the ability of daily activities.

湖南省科技厅重点资助项目（2016SK2034）