目的 探讨阿加曲班注射液联合羟乙基淀粉130/0.4氯化钠注射液治疗分水岭脑梗死的临床效果。方法 选取2016年7月-2018年3月在徐州矿务集团总医院治疗的急性分水岭脑梗死患者100例为研究对象，将所有患者随机分为对照组和治疗组，每组各50例。对照组静脉滴注羟乙基淀粉130/0.4氯化钠注射液，500 mL/次，1次/d；治疗组在对照组治疗的基础上静脉滴注阿加曲班注射液，10 mg加入生理盐水40 mL中，1次/4 h，持续48 h，然后10 mg加入生理盐水100 mL中，2次/d。两组患者均连续治疗14 d。观察两组患者的临床疗效，同时比较治疗前后两组的国立卫生研究院卒中量表（NIHSS）评分、改良Rankin评分（mRS）、BI评分、S100β蛋白（S100β）和血凝指标水平。结果 治疗后，对照组和治疗组的总有效率为76.00%、90.00%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组NIHSS和mRS评分明显降低，BI评分明显升高，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，治疗组NIHSS、mRS和BI评分明显优于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组S100β、D-二聚体（D-D）和纤维蛋白原（FIB）水平均明显降低，抗凝血酶（AT）、活化部分凝血活酶时间（APTT）水平明显上升，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，治疗组S100β和血凝指标水平显著优于对照组，两组比较差异具有统计学意义（P<0.05）。结论 阿加曲班注射液联合联合羟乙基淀粉130/0.4氯化钠注射液治疗分水岭脑梗死具有较好的临床疗效，可有效改善患者日常行为能力，降低脑细胞受损程度，改善神经功能，具有较好的临床推广应用价值。

Objective To explore the clinical effect of Argatroban Injection combined with Hydroxyethyl Starch 130/0.4 and Sodium Chloride Injection in treatment of cerebral watershed infarction. Methods Patients (100 cases) with cerebral watershed infarction in Xuzhou Mining Group General Hospital from July 2016 to March 2018 were randomly divided into control and treatment groups, and each group had 50 cases. Patients in the control group were iv administered with Hydroxyethyl Starch 130/0.4 and Sodium Chloride Injection, 500 mL/time, once daily. Patients in the treatment group were iv administered with Argatroban Injection on the basis of the control group, 10 mg added into normal saline 40 mL, once every 4 h, maintained for 48 h, then 10 mg added into normal saline 100 mL, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and NIHSS scores, mRS, BI scores, S100β, and the coagulation indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 76.00% and 90.00%, respectively, and there was significant difference between two groups (P<0.05). After treatment, NIHSS and mRS scores in two groups were significantly decreased, but BI scores in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). After treatment, NIHSS, mRS, and BI scores in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, S100β, D-D and FIB levels in two groups were significantly decreased, but AT and APTT in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). After treatment, S100β and coagulation indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Argatroban Injection combined with Hydroxyethyl Starch 130/0.4 and Sodium Chloride Injection has clinical curative effect in treatment of cerebral watershed infarction, can effectively improve patients' daily behavior ability, reduce the degree of damage to brain cells, and improve neurological function, which has a certain clinical application value.

江苏省卫生计生委科研课题（Z201513）