目的 观察依达拉奉联合胞二磷胆碱治疗急性缺血性脑梗死的临床疗效和安全性。方法 上海市同仁医院2009年5月—2013年5月入院治疗的急性脑梗死患者90例，随机分为依达拉奉组、胞二磷胆碱组和联合用药组，每组30例。在常规治疗基础上，依达拉奉组单用依达拉奉30 mg/次，2次/d；胞二磷胆碱组单用胞磷胆碱，750 mg/d；联合用药组联用两药。3组疗程均为14 d。治疗前及后14、90 d，测量患者血清超氧物歧化酶（SOD）、神经元特异性烯醇化酶（NSE）、高敏感性C-反应蛋白（Hs-CRP）水平，评定神经功能缺损、日常生活能力、运动功能，分析临床疗效，检测药物安全性。结果 3组治疗前血清中SOD、NSE、Hs-CRP水平以及NIHSS、ADL及MAS分数无统计学差异（P＞0.05）；治疗后14 d，联合用药组SOD高于依达拉奉组（P＞0.05）、胞二磷胆碱组（P＜0.05）组，NSE、Hs-CRP低于依达拉奉组、胞二磷胆碱组（P＞0.05）；治疗后90 d，联合用药组SOD高于依达拉奉组、胞二磷胆碱组（P＜0.05），NSE、Hs-CRP低于依达拉奉组、胞二磷胆碱组（P＜0.05）。3组NIHSS分数在治疗后14、90 d降低（P＜0.05），ADL及MAS分数升高（P＜0.05）；联合用药组NIHSS分数在治疗后14、90 d明显低于依达拉奉组、胞二磷胆碱组（P＜0.05），ADL及MAS分数明显高于依达拉奉组、胞二磷胆碱组（P＜0.05）。联合用药组治疗后14 d疗效分布与依达拉奉组、胞二磷胆碱组比较具有统计学差异（P＜0.05）。联合用药组14、90 d后治疗有效例数及总有效率均高于依达拉奉组、胞二磷胆碱组。暂未发现严重不良反应。结论 相较单用依达拉奉或胞磷胆碱，两药联合运用更能有效减少自由基水平、保护神经元，更好地改善病情及预后，更有利于神经功能、日常生活能力、运动功能恢复。

Objective To study the clinical efficacy and safety of edaravone combined with citicoline in the treatment of acute ischemic cerebral infarction. Methods The patients (90 cases) diagnosed as acute cerebral infarction in Shanghai Tong Ren Hospital from May 2009 to May 2012 were randomly divided into edaravone group, citicoline group, and combination group, each had 30 cases. On the basis of conventional therapy, the patients in the edaravone group were given edaravone, in the citicoline group were given citicoline, while in the combination group were given edaravone combined with citicoline for 14 d. Before the treatment, 14 d, and 90 d after the administration, the clinical efficacy and the changes of superoxide dismutase (SOD), neuronspecific enolase (NSE), and high-sensitivity C-reactive protein (Hs-CRP) levels were observed, and NHISS, ADL, and MAS were tested. Results Before the treatment, SOD, NSE, and Hs-CRP levels as well as NHISS, ADL, and MAS tests scores in the three groups had no statistical difference (P > 0.05). The SOD level in the combination group was higher than that in the edaravone group (P > 0.05) and the citicoline group (P < 0.05), while NSE and Hs-CRP levels in the combination group was less than those in the edaravone group and citicoline group (P > 0.05) in 14 d after the treatment. The SOD level in the combination group was higher than that in the edaravone group and citicoline group (P < 0.05), while NSE and Hs-CRP levels in the combination group were less than those in the edaravone group and citicoline group (P < 0.05) in 90 d after the treatment. Compared with the scores before the treatment, NIHSS scores in the all three groups decreased (P < 0.05), while ADL and MAS scores increased (P < 0.05) in 14 and 90 d after the treatment. Also NIHSS scores in the combination group were significantly lower than those in the edaravone group and citicoline group (P < 0.05), and its ADL and MAS scores were significantly higher than those in the edaravone group and citicoline group (P < 0.05). On day 14, the distribution of efficacy in the combination group had statistically significant difference compared with that in the edaravone group and citicoline group (P <0.05). The effective cases and rate in the combination group were higher than the number in the edaravone group and citicoline group in 14 and 90 d after the treatment. No serious adverse reactions had been reported. Conclusion Compared the treatment with the application of edaravone or citicoline alone, the combined use of the two drugs is more effective to the removal of free radicals, neurons protecion, the recovery of nerve function, daily function, and motor function, thereby improving the condition and prognosis.