目的 探讨华法林钠片联合替格瑞洛片治疗急性心肌梗死的临床疗效。方法 选择2019年4月-2020年4月在河南省中医药研究院附属医院治疗的急性心肌梗死患者90例，根据住院号分为对照组（45例）和治疗组（45例）。对照组口服替格瑞洛片，起始剂量180 mg/次，此后90 mg/次，2次/d。治疗组在对照组基础上口服华法林钠片，第1~3天3~4 mg，3 d后可给维持量2.5~5 mg/d。两组患者均经2周治疗。观察两组患者临床疗效，同时比较治疗前后两组患者左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室收缩末期容积（LVESV）、左室舒张末期内经（LVEDD）、血管生长因子B（VEGF-B）、可溶性细胞间黏附分子-1（sICAM-1）、半乳凝素-3（Gal-3）、基质金属蛋白酶-9（MMP-9）、内皮素（ET）和一氧化氮（NO）水平，及QRS积分和心肌梗死面积。结果 治疗后，对照组和治疗组临床有效率分别为80.00%和95.56%，两组比较差异有统计学意义（P<0.05）。治疗后，两组LVEDD、LVESV和LVESD明显下降（P<0.05），而LVEF明显升高（P<0.05），且治疗组心功能指标明显好于对照组（P<0.05）。治疗后，两组Gal-3明显升高（P<0.05），而MMP-9明显降低（P<0.05），且治疗组Gal-3和MMP-9水平明显好于对照组（P<0.05）。治疗后，两组患者ET和sICAM-1明显降低（P<0.05），而VEGF-B和NO明显升高（P<0.05），且治疗组水平明显好于对照组（P<0.05）。治疗后，两组QRS积分和心肌梗死面积明显减小（P<0.05），且治疗组明显小于对照组（P<0.05）。结论 华法林钠片联合替格瑞洛片治疗急性心肌梗死可有效改善患者心功能，改善心肌重构，促进血管内皮细胞功能改善，具有一定的临床推广应用价值。

Objective To explore the clinical effect of warfarin combined with tegrilol in treatment of acute myocardial infarction. Methods Patients (90 cases) with acute myocardial infarction in the Affiliated Hospital of Henan Academy of Chinese Medicine from April 2019 to April 2020 were divided into control (45 cases) and treatment (45 cases) groups based on hospitalization number. Patients in the control group were po administered with Ticagrelor Tablets, the initial dose was 180 mg/time, then 90 mg/time, twice daily. Patients in the treatment group were po administered with Warfarin Sodium Tablets on the basis of the control group, 3-4 mg for the first to third day, and then the maintain the dose was 2.5-5 mg/d after 3 days. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the levels of LVEDD, LVESV, LVESD, LVEF, Gal-3, MMP-9, ET, sICAM-1, VEGF-B and NO, the QRS scores and myocardial infarction area in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 80.00% and 95.56%, respectively, and there were differences between two groups (P<0.05). After treatment, the LVEDD, LVESV, and LVESD in two groups were significantly decreased (P<0.05), but LVEF were significantly increased (P<0.05), and these cardiac function indexes in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the Gal-3 in two groups was significantly increased (P<0.05), but MMP-9 was significantly decreased (P<0.05), and the Gal-3 and MMP-9 in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the ET and sICAM-1 in two groups were significantly decreased (P<0.05), but the VEGF-B and NO were significantly increased (P<0.05), and these vascular endothelial cytokines levels in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the QRS scores and myocardial infarction area in two groups were significantly reduced (P<0.05), and which in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion warfarin combined with tegrilol in treatment of acute myocardial infarction can effectively improve the cardiac function, myocardial remodeling, and improve the function of vascular endothelial cells, which has a certain clinical application value.

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