目的 探讨银杏叶提取物注射液联合阿加曲班治疗急性脑梗死的临床疗效。方法 选取2020年1月—2021年12月定州市人民医院收治的126例急性脑梗死患者，按照随机数字表法将所有患者分为对照组和治疗组，每组各63例。对照组给予阿加曲班注射液，开始以2.5 mg/h的速率持续静脉泵入，连用2 d；随后调整为10 mg/次，每日早晚各1次，每次静脉滴注3 h，连续5 d。治疗组在对照组基础静脉滴注银杏叶提取物注射液，每次将20 mL加生理盐水入250 mL中充分稀释，1次/d。两组疗程均为14 d。观察两组的临床疗效，比较治疗前后两组相关量表[简式Fugl-Meyer评定量表（FMA）、脑卒中自我效能问卷（SSEQ）、美国国立卫生研究院卒中量表（NIHSS）]评分，凝血功能指标[活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、D-二聚体（D-D）]，血液流变学参数[血浆黏度（PV）、红细胞聚集指数（EAI）、红细胞比容（HCT）、红细胞沉降率（ESR）]及血清同型半胱氨酸（Hcy）、血管内皮生长因子（VEGF）、可溶性CD40配体（sCD40L）水平。结果 治疗后，治疗组总有效率是95.24%，显著高于对照组的84.13%（P＜0.05）。治疗后，两组FMA、SSEQ评分均显著增加，NIHSS评分均显著减少（P＜0.05）；治疗后，各评分改善以治疗组更显著（P＜0.05）。治疗后，两组APTT、PT均显著延长，血浆FIB、D-D水平均显著降低（P＜0.05），均以治疗组改善更显著（P＜0.05）。治疗后，两组PV、EAI、HCT、ESR均较治疗前显著降低（P＜0.05），以治疗组改善更显著（P＜0.05）。治疗后，两组血清Hcy、sCD40L水平均显著下降，血清VEGF水平均显著上升（P＜0.05）；且治疗后，治疗组血清Hcy、VEGF、sCD40L水平改善均显著优于对照组（P＜0.05）。结论 银杏叶提取物注射液联合阿加曲班治疗急性脑梗死有确切的临床疗效，在改善患者运动功能、自我效能及神经功能缺损方面均可获得较为满意的效果，且能安全有效地促进凝血功能与血液流变性的恢复、减轻机体炎性损伤和内皮损伤，值得临床推广应用。

Objective To investigate the clinical efficacy of Extract of Ginkgo Biloba Leaves Injection combined with argatroban in treatment of acute cerebral infarction. Methods A total of 126 patients with acute cerebral infarction admitted to Dingzhou People’s Hospital from January 2020 to December 2021 were selected and divided into control group and treatment group according to random number table method, with 63 cases in each group. Patients in the control group were given Argatroban Injection, intravenously pumped at a rate of 2.5 mg/h for 2 d. Subsequently, the dosage was adjusted to 10 mg/time, once in the morning and once in the evening, for 3 h each time for consecutive 5 d. Patients in the treatment group were iv administered with Extract of Ginkgo Biloba Leaves Injection on the basis of the control group, added 20 mL into normal saline 250 mL for full dilution, once daily. The treatment course of both groups was 14 d. After treatment, the clinical efficacy was evaluated, the scores of related scales [Simple Fugl-Meyer Rating Scale (FMA), Stroke Self-efficacy Questionnaire (SSEQ), National Institutes of Health Stroke Scale (NIHSS)], coagulation function indexes [activation part, thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D)], hemorheological parameters [plasma viscosity (PV), erythrocyte aggregation index (EAI), hematocrit (HCT), erythrocyte sedimentation rate (ESR)], and serum homocysteine (Hcy), vascular endothelial growth factor (VEGF), soluble CD40 ligand (sCD40L) levels were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 95.24%, which was significantly higher than that of the control group (84.13%, P < 0.05). After treatment, FMA and SSEQ scores were significantly increased, while NIHSS scores were significantly decreased in both groups (P < 0.05). After treatment, the scores improved more significantly in the treatment group (P < 0.05). After treatment, APTT and PT in two groups were significantly prolonged, plasma FIB and D-D levels were significantly decreased (P < 0.05), and the improvement was more significant in the treatment group (P < 0.05). After treatment, PV, EAI, HCT, and ESR in two groups were significantly decreased compared with before treatment (P < 0.05), and the improvement was more significant in the treatment group (P < 0.05). After treatment, serum Hcy and sCD40L levels were significantly decreased, and serum VEGF levels were significantly increased in two groups (P < 0.05). After treatment, the improvement of serum Hcy, VEGF and sCD40L levels in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion Extract of Ginkgo Biloba Leaves Injection combined with argatroban has a definite curative effect in treatment of acute cerebral infarction, and can achieve satisfactory results in improving motor function, self-efficacy and neurological deficit of patients, and can safely and effectively promote the recovery of blood coagulation function, hemological rheology, and alleviate the inflammatory injury and endothelial injury, which is worthy of clinical application.

R971

河北省卫生厅科研计划项目（20191745）