目的 探讨消栓肠溶胶囊联合阿替普酶治疗急性脑梗死的临床疗效。方法 选取2016年2月-2017年4月在漯河市中医院治疗的急性脑梗死患者94例，根据用药的差别分为对照组（47例）和治疗组（47例）。对照组静脉推入注射用阿替普酶，先以总剂量的10%按0.9 mg/kg（最大剂量为90 mg）的量推入，剩余剂量加入100 mL生理盐水，60 min持续静脉滴注，1次/d。治疗组在对照组基础上口服消栓肠溶胶囊，0.4 g/次，3次/d。两组患者均连续治疗2周。观察两组患者临床疗效，比较治疗前后两组患者NIHSS、FMI和MBI评分及血清学指标和血液流变学指标。结果 治疗后，对照组临床有效率为82.98%，显著低于治疗组的97.87%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组NIHSS评分显著降低，FMI和MBI评分显著增加，同组比较差异具有统计学意义（P<0.05）；且治疗后治疗组上述评分明显优于对照组（P<0.05）。治疗后，两组患者血清脂蛋白磷脂酶A2（Lp-PLA2）、血小板活化因子（PAF）、淀粉样蛋白（SAA）水平显著降低，神经生长因子（NGF）和胰岛素样生长因子-1（IGF-1）水平显著增加，同组比较差异具有统计学意义（P<0.05）；且治疗组上述血清学指标水平明显优于对照组（P<0.05）。治疗后，两组患者全血黏度（WBV）、血浆黏度（PV）、纤维蛋白原（FIB）和血小板黏附率（PAR）均显著降低（P<0.05）；且治疗组血液流变学指标显著低于对照组（P<0.05）。结论 消栓肠溶胶囊联合阿替普酶治疗急性脑梗死可有效降低机体炎症水平，促进神经细胞因子分泌，改善机体血液流变学指标。

Objective To evaluate the clinical efficacy of Xiaoshuan Enteric-coated Capsules combined with alteplase in treatment of acute cerebral infarction. Methods Patients (94 cases) with acute cerebral infarction in Luohe Hospital of Chinese Medicine from February 2016 to April 2017 were divided into control (47 cases) and treatment (47 cases) based on different treatments. Patients in the control group were intravenous injection administered with Alteplase for injection, firstly, 0.9 mg/kg of 10% of the total dose and the maximum dose was 90 mg, the residual dose was added into normal saline 100 mL for 60 min. Patients in the treatment group were po administered with Xiaoshuan Enteric-coated Capsules on the basis of the control group, 0.4 g/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the NIHSS, FMI and MBI scores, the serological indexes and the hemorheological indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 82.98%, which was significantly lower than 97.87% in the treatment group, and there were differences between two groups (P < 0.05). After treatment, the NIHSS score in two groups was significantly decreased, but FMI and MBI scores were significantly increased, and the difference was statistically significant in the same group (P < 0.05), and these scores in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the Lp-PLA2, PAF and SAA levels in two groups were significantly decreased, but NGF and IGF-1 levels were significantly increased, and there were differences in the same group (P < 0.05), and the serological indexes in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the WBV, PV, FIB and PAR levels in two groups were significantly decreased (P < 0.05), and the hemorheological indexes in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Xiaoshuan Enteric-coated Capsules combined with alteplase in treatment of acute cerebral infarction can effectively reduce the level of inflammatory, promoting the secretion of nerve cytokines and improve the hemorheological indexes.