目的 探讨天龙熄风颗粒联合注射用阿替普酶治疗急性脑梗死的临床疗效。方法 选取2017年1月-2019年1月天津市宁河区医院收治的120例急性脑梗死患者为研究对象，采用随机数字表法将所有患者分为对照组和治疗组，每组各60例。对照组患者给予注射用阿替普酶，0.6 mg/kg，起始的10%剂量在60 s内静脉注射，剩余的90%剂量用微量注射泵静脉泵入，1次/d。治疗组在对照组治疗的基础上口服天龙熄风颗粒，9 g/次，3次/d。两组均连续治疗2周。观察两组的临床疗效，比较两组的美国国立卫生院神经功能缺损评分（NIHSS）评分、Barthel指数、凝血功能指标、血清因子水平。结果 治疗后，对照组和治疗组的总有效率分别为75.00%、91.67%，两组比较差异有统计学意义（P<0.05）。治疗后，两组的NIHSS评分显著下降，Barthel指数显著升高，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗后治疗组的NIHSS低于对照组，Barthel指数高于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，两组凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）明显增加，血清纤维蛋白原（FIB）水平明显下降，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗后治疗组的PT和APTT长于对照组，血清FIB水平低于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，两组血清C反应蛋白（CRP）、可溶性白细胞分化抗原40配体（sCD40L）水平均明显下降，血清白细胞介素-10（IL-10）水平均明显升高，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗后治疗组的血清CRP、sCD40 L水平均低于对照组，血清IL-10水平明显高于对照组，两组比较差异有统计学意义（P<0.05）。结论 天龙熄风颗粒联合注射用阿替普酶治疗急性脑梗死的临床疗效显著，能改善神经功能和凝血功能，提高日常生活能力，降低炎症反应，安全性较好，具有一定的临床推广应用价值。

Objective To explore clinical efficacy of Tianlong Xifeng Granules combined with Alteplase for injection in treatment of acute cerebral infarction. Methods Patients (120 cases) with acute cerebral infarction in Tianjin Ninghe Hospital from January 2017 to January 2019 were randomly divided into control and treatment groups, and each group had 60 cases. Patients in the control group were given Alteplase for injection, 0.6 mg/kg, initial 10% dose was injected intravenously within 60 seconds, and the remaining 90% dose was pumped intravenously with a microinjection pump, once daily. Patients in the treatment group were po administered with Tianlong Xifeng Granules on the basis of the control group, 9 g/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, and NIHSS scores, Barthel indexes, coagulation function indexes, and serum factors level in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 75.00% and 91.67%, respectively, and there was difference between two groups (P<0.05). After treatment, NIHSS scores in two groups were significantly decreased, but Barthel indexes in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the score indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, PT and APTT in two groups were significantly increased, but FIB in two groups was significantly increased, and the difference was statistically significant in the same group (P<0.05). And the coagulation function indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of CRP and sCD40L in two groups were significantly decreased, but the levels of IL-10 in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the serum factors levels in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Tianlong Xifeng Granules combined with Alteplase for injection in treatment of acute cerebral infarction has a significant efficacy, can significantly improve nerve coagulation and function, improve daily living ability, reduce inflammation, which has a certain clinical application value.