目的 探讨丹灯通脑软胶囊联合阿加曲班注射液治疗急性脑梗死的临床疗效。方法 选取2022年3月—2024年3月宝鸡市人民医院收治的急性脑梗死患者124位，随机将患者分为对照组和治疗组，每组各62例。对照组静脉滴注阿加曲班注射液，前2天每天6支，用250 mL生理盐水稀释，24 h持续静脉滴注给药，接下来的5 d，1支/次，早晚各1次，每次滴注时间为3 h。治疗组在对照组基础上口服丹灯通脑软胶囊，4粒/次，3次/d，连续给药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）评分和Barthel指数（BI），及中枢神经系统特异性蛋白（S100β）、神经元特异性烯醇化酶（NSE）、神经生长因子（NGF）和神经营养因子（NTF）、最大峰值流速（Vs）、舒张末流速（Vd）、平均流速（Vm）、血管搏动指数（PI）和血管阻力指数（RI）水平。结果 治疗后，治疗组和对照组的总有效率分别达到93.55%和85.48%，两组差异具有统计学意义（P＜0.05）。治疗后，两组患者NIHSS评分比治疗前明显降低，而BI评分则显著升高（P＜0.05）；另外，治疗组评分显著好于对照组（P＜0.05）。治疗后，两组患者S100β和NSE的浓度均显著下降，而NGF和NTF水平则呈现显著提升（P＜0.05）；且治疗组血清神经细胞因子的改善情况明显优于对照组（P＜0.05）。治疗后，治疗组最大峰值流速（V_s）、舒张末流速（V_d）、平均流速（V_m）、血管搏动指数（PI）水平均明显升高，而血管阻力指数（RI）水平均显著下降（P＜0.05），且治疗组脑血流动力学参数改善情况显著优于对照组（P＜0.05）。结论 丹灯通脑软胶囊与阿加曲班注射液联用，对于治疗急性脑梗死，可产生协同效应，进而增强临床疗效。此方案有助于改善神经功能缺损，并提升患者的日常生活自理能力，调节神经细胞因子水平，并改善脑血流动力学。

Objective To explore the clinical efficacy of Dandeng Tongnao Soft Capsules combined with Argatroban Injection in treatment of acute cerebral infarction. Methods Patients (124 cases) with acute cerebral infarction in Baoji People′s Hospital from March 2022 to March 2024 were randomly divided into control and treatment group, and each group had 62 cases. Patients in the control group were iv administered with Argatroban Injection, 6 vials/d for two days, the injection was added into 250 mL normal saline, they were continuously intravenous infused for 24 h, 1 vial/d for the next 5 d, they were continuously intravenous infused for 3 h, and twice daily. Patients in the treatment group were po administered with Dandeng Tongnao Soft Capsules on the basis of the control group, 4 grains/time, three times daily. Patients in two groups were treated for 14 d. After treatment, the clinical evaluations were evaluated, and the NIHSS and BI scores, the levels of S-100β, NSE, NGF, NTF, V_s, V_d, V_m, PI and RI in two groups before and after treatment were compared. Results After treatment, the total effective rates in the treatment group and the control group reached 93.55% and 85.48%, respectively, and the difference between the two groups was statistically significant (P < 0.05). After treatment, the NIHSS score in two groups was significantly lower than that before treatment, while the BI score was significantly higher (P < 0.05); in addition, the scores of the treatment group were significantly better than that of the control group (P < 0.05). After treatment, the concentrations of S100β and NSE in two groups were significantly decreased, while the levels of NGF and NTF were vsignificantly increased (P < 0.05); and the improvement of serum neurocytokines in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the levels of V_s, V_d, V_m, and PI in the treatment group were all significantly increased, while the level of RI was significantly decreased (P < 0.05). The improvement of cerebral hemodynamic parameters in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion The combination of Dandeng Tongnao Soft Capsules and Argatroban Injection can exert a synergistic effect in the treatment of acute cerebral infarction, improve clinical efficacy, enhance neurological deficit function and daily living ability, regulate levels of nerve cytokines, and improve cerebral hemodynamics.

R971

陕西省卫生健康科研基金资助项目（2023D095）