目的 探討注射用七葉皂苷鈉聯(lián)合替羅非班治療急性腦梗死的臨床療效。方法 選取2018年3月—2021年12月太和縣人民醫(yī)院收治的94例急性腦梗死患者，按隨機數(shù)字表法將所有患者分為對照組和治療組，每組各47例。對照組靜脈滴注鹽酸替羅非班氯化鈉注射液，前30 min滴注速率是0.4 μg/（kg·min），維持滴速是0.1 μg/（kg·min）。治療組在對照組基礎上靜脈滴注注射用七葉皂苷鈉治療，10 mg加入0.9%氯化鈉注射液250 mL中充分溶解、稀釋，2次/d。連續(xù)治療14 d后觀察兩組臨床療效。比較治療前后兩組相關量表評分、洼田飲水試驗評級、血漿纖維蛋白原（FIB）、D-二聚體（D-D）水平，血小板最大聚集率（MAR）、血清C反應蛋白（CRP）水平及外周血中性粒細胞與淋巴細胞比值（NLR）、血小板與淋巴細胞比值（PLR）。結果 治療后，治療組總有效率是93.6%，較對照組78.7%顯著升高（P<0.05）。治療后，兩組患者NIHSS評分較治療前均顯著降低（P<0.05），且治療后治療組各時點NIHSS評分均低于對照組（P<0.05）。治療后，兩組洼田飲水試驗評級和mRS評分均顯著降低，MBI評分均顯著增加（P<0.05）；且均以治療組改善更顯著（P<0.05）。治療后，兩組血漿FIB、D-D水平、MAR均顯著降低（P<0.05），且治療組血漿FIB、D-D水平和MAR均低于對照組（P<0.05）。治療后，兩組血清CRP水平和外周血NLR、PLR均較治療前顯著下降（P<0.05）；且治療后，治療組血清CRP水平和外周血NLR、PLR均顯著低于對照組（P<0.05）。結論 注射用七葉皂苷鈉聯(lián)合替羅非班治療急性腦梗死的整體療效確切，能有效抑制血栓形成、減輕機體炎性損傷，促進患者神經功能、吞咽功能和日常生活能力的恢復，且安全性較好。

Objective To investigate the clinical efficacy of Sodium Aescinate for injection combined with tirofiban in treatment of acute cerebral infarction. Methods A total of 94 patients with acute cerebral infarction admitted to Taihe County People's Hospital from March 2018 to December 2021 were selected and divided into control group and treatment group according to the random number table method, with 47 cases in each group. Patients in the control group were iv administered with Tirofiban Hydrochloride and Sodium Chloride Injection, the infusion rate was 0.4 μg/(kg∙min) for the first 30 minutes and 0.1 μg/(kg∙min) was maintained. Patients in the treatment group were iv administered with Sodium Aescinate for injection on the basis of the control group, 10 mg was added into 0.9% sodium chloride injection 250 mL to fully dissolve and dilute, twice daily. The clinical efficacy of the two groups was observed after 14 d of continuous treatment. Before and after treatment, the National Institutes of Health Stroke Scale (NIHSS) score, Kubota drinking test score, Modified Rankin Scale (mRS) score, Modified Barthel Index (MBI) score, plasma fibrinogen (FIB), D-Dimer (D-D) level, platelet maximum aggregation rate (MAR), serum C-reactive protein (CRP) level, and peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) of the two groups were compared. Results After treatment, the total effective rate of the treatment group was 93.6%, which was significantly higher than 78.7% of the control group (P < 0.05). After treatment, the NIHSS score of the two groups was significantly lower than that before treatment (P < 0.05), and the NIHSS score of the treatment group was lower than that of the control group at each time point after treatment (P < 0.05). After treatment, the drinking water test rating and mRS score of the two groups were significantly decreased, and the MBI score was significantly increased (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, the plasma levels of FIB, D-D and MAR in the two groups were significantly decreased (P < 0.05), and the plasma levels of FIB, D-D and MAR in the treatment group were lower than those in the control group (P < 0.05). After treatment, the levels of serum CRP, peripheral blood NLR and PLR in the two groups were significantly decreased compared with those before treatment (P < 0.05). After treatment, the serum CRP level, peripheral blood NLR and PLR in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Sodium Aescinate for injection combined with tirofiban has a definite overall efficacy in treatment of acute cerebral infarction, and can effectively inhibit thrombosis, reduce inflammatory injury, promote the recovery of neurological function, swallowing function and daily living ability of patients, which has good safety.

R971

阜陽市自籌經費科技計劃項目（FK202081805）