目的 探讨脑得生丸联合阿加曲班治疗急性脑梗死的临床疗效。方法 选取2021年1月至2022年12月淮南市新华医疗集团新华医院收治的106例急性脑梗死患者，按随机数字表法分为对照组和治疗组，每组各53例。对照组静脉滴注阿加曲班注射液，先以2.5 mg/h的速率持续静脉内泵入，连续用药48 h；之后调整为10 mg/次，每次间隔12 h，每次给药时间≥3 h，连续5 d；阿加曲班的总治疗时间为7 d，其用药结束后对患者继续实施常规对症治疗。治疗组在对照组治疗基础上口服脑得生丸，2 g/次，3次/d。两组连续治疗14 d。观察两组的临床疗效，比较治疗前后神经功能缺损情况、血栓弹力图指标及凝血功能指标。结果 治疗后，治疗组总有效率是94.34%，显著高于对照组的81.13%（P＜0.05）。治疗后，两组患者美国国立卫生研究院卒中量表（NIHSS）评分均显著低于同组治疗前（P＜0.05），且治疗组治疗3、7、14 d后NIHSS评分均低于同期对照组（P＜0.05）。治疗后，两组患者凝固角（Angle）、凝血综合指数（CI）、血栓最大强度（MA）均较治疗前显著降低，而凝血反应时间（R）升高（P＜0.05）；治疗后，治疗组Angle、CI、MA均低于对照组，而R值高于对照组（P＜0.05）。治疗后，两组纤维蛋白原（FIB）、D-二聚体（D-D）、纤维蛋白降解产物（FDP）均较治疗前显著降低，而抗凝血酶Ⅲ（AT-Ⅲ）显著升高（P＜0.05）；治疗后，治疗组FIB、D-D、FDP均低于对照组，而AT-Ⅲ高于对照组（P＜0.05）。结论 脑得生丸联合阿加曲班治疗急性脑梗死可取得较好的效果，可有效逆转患者体内高凝状态、抑制血栓形成，对减轻神经损伤具有十分重要的作用，且安全性好，值得临床推广应用。

Objective To explore the clinical efficacy of Naodesheng Pills combined with agatroban in treatment of acute cerebral infarction. Methods A total of 106 patients with acute cerebral infarction admitted to Xinhua Hospital of Xinhua Medical Group in Huainan from January 2021 to December 2022 were selected and divided into control group and treatment group according to random number table method, with 53 patients in each group. Patients in the control group were iv administered with Argatroban Injection, the drug was injected intravenously at a rate of 2.5 mg/h for 48 h. Then the dosage was adjusted to 10 mg/time, each time at an interval of 12 h, each administration time ≥ 3 h, 5 d. The total treatment time of agatroban was 7 d, and the conventional symptomatic treatment was continued after the end of the treatment. Patients in the treatment group were po administered with Naodesheng Pills on the basis of the control group, 2 g/time, three times daily. The two groups were treated continuously for 14 d. The clinical effects of the two groups were observed, and the neurological defects, thromboelastogram indexes and coagulation function indexes were compared before and after treatment. Results After treatment, the total effective rate of treatment group was 94.34%, which was significantly higher than that of control group (81.13%, P < 0.05). After treatment, the National Institutes of Health Stroke Scale (NIHSS) scores of the two groups were significantly lower than before treatment (P < 0.05), and the NIHSS scores of treatment group were lower than those of control group after 3, 7 and 14 days of treatment (P < 0.05). After treatment, the coagulation Angle (Angle), coagulation composite index (CI) and maximum thrombus intensity (MA) in 2 groups were significantly decreased compared with before treatment, but coagulation reaction time (R) was increased (P < 0.05). After treatment, Angle, CI and MA in the treatment group were lower than those in control group, while R value was higher than that in control group (P < 0.05). After treatment, fibrinogen (FIB), D-dimer (D-D) and fibrin degradation product (FDP) in 2 groups were significantly decreased compared with before treatment, but antithrombin Ⅲ (AT-Ⅲ) was significantly increased (P < 0.05). After treatment, FIB, D-D and FDP in treatment group were lower than those in control group, while AT-Ⅲ was higher than that in the control group (P < 0.05). Conclusion Naodesheng Pills combined with agatroban can achieve better results in treatment of acute cerebral infarction, and can effectively reverse the hypercoagulable state in patients and inhibit thrombosis, has a very important role in alleviating nerve damage with good safety, which is worthy of clinical application.

R971

吴阶平医学基金会临床科研专项资助项目（320.6750.2020-06-60）