目的 探讨马来酸桂哌齐特联合西洛他唑治疗下肢动脉硬化闭塞症的临床疗效。方法 选取2018年1月—2019年6月在三门峡市中心医院收治的176例下肢动脉硬化闭塞症患者，随机分为对照组和治疗组，每组各88例。对照组患者口服西洛他唑片，100 mg/次，2次/d。治疗组患者在对照组治疗基础上静脉滴注马来酸桂哌齐特注射液，320 mg加入生理盐水500 mL，1次/d。两组患者均连续治疗2周。观察两组的临床疗效，比较两组治疗前后小腿部位皮温、足背动脉超声检查指标、血流动力学指标、炎症因子和氧化应激指标的变化情况。结果 治疗后，对照组总有效率78.41%，治疗组总有效率93.18%，两组比较差异具有统计学意义（P<0.05）。治疗后，对照组与治疗组患者小腿部位皮温较治疗前均显著提高，两组比较差异具有统计学意义（P<0.05）；且治疗后治疗组患者小腿部位皮温提高更明显，差异存在统计学意义（P<0.05）。治疗后，对照组与治疗组患者足背动脉血管内径、血流量较治疗前均显著提高（P<0.05），但峰值速度显著下降（P<0.05）；且治疗组上述指标改善更明显（P<0.05）。治疗后，两组患者全血高切黏度、全血低切黏度、血浆黏度、细胞沉降率水平较治疗前均有显著降低（P<0.05）；且治疗组患者血流动力学指标降低的更明显（P<0.05）。治疗后，两组肿瘤坏死因子-α（TNF-α）、细胞间黏附分子-1（ICAM-1）、白细胞介素-8（IL-8）水平较治疗前均有显著降低（P<0.05）；且治疗组患者血清炎症因子水平降低更明显（P<0.05）。治疗后，两组丙二醛（MDA）、过氧化脂质（LPO）水平较治疗前均显著下降（P<0.05）；且治疗组患者血清氧化应激指标水平下降更明显（P<0.05）。结论 桂哌齐特联合西洛他唑治疗下肢动脉硬化闭塞症具有较好的临床疗效，可显著促进患者的恢复，促进局部血液循环，减少炎症因子和氧化应激产物的生成，具有一定的临床推广应用价值。

Objective To explore the clinical effect of cinepazide maleate combined with cilostazol in treatment of lower extremity arteriosclerosis obliterans. Methods Patients (176 cases) with lower extremity arteriosclerosis obliterans in Sanmenxia Central Hospital from January 2018 to June 2019were randomly divided into control and treatment groups with 88 cases in each group. The control group po administered with Cilostazol Tablets, 100 mg/time, twice daily. The treatment group was iv administered with Cinepazide Maleate Injection on the basis on of the control group, 320 mg added 500 mL of normal saline, once daily. All patients were treated for 2 weeks. The clinical efficacy was observed, and the changes of skin temperature of the lower leg, ultrasonic examination indexes of the dorsal artery of the foot, hemodynamic indexes, inflammatory factors and oxidative stress indexes in two groups before and after the treatment were compared. Results After treatment, the total effective rates of the control group and the treatment group were 78.41% and 93.18%, respectively, the total effective rate of the two groups was statistically significant (P<0.05). The skin temperature in the lower leg of both the control group and the treatment group was significantly higher than that before treatment (P<0.05). After treatment, the skin temperature of the lower leg of the patients in the treatment group increased more obviously (P<0.05). After treatment, both the control group and the treatment group showed a significant increase in the vascular diameter and blood flow of the dorsalis pedis (P<0.05), but the peak speed decreased significantly (P<0.05). The improvement of the above indexes was more obvious in the treatment group (P<0.05). After treatment, the levels of whole blood high cutting viscosity, whole blood low cutting viscosity, plasma viscosity and cell sedimentation rate in the two groups were significantly lower than those before treatment (P<0.05). In addition, the hemodynamic index of patients in the treatment group was more significantly reduced (P<0.05).After treatment, TNF-α, ICAM-1 and IL-8 levels in both groups were significantly reduced compared with those before treatment (P<0.05). Moreover, the level of serum inflammatory factors in the treatment group was more significantly reduced (P<0.05). After treatment, the levels of MDA and LPO in the two groups decreased significantly compared with those before treatment (P<0.05). Moreover, the level of serum oxidative stress indexes in the treatment group decreased more significantly (P<0.05). Conclusion Cinepazide maleate combined with cilostazol has a good clinical effect in treatment of lower extremity arteriosclerosis obliterans, and can significantly promote the recovery, promote the local blood circulationand, and can reduce the generation of inflammatory factors and oxidative stress products, which has a certain clinical application value.

R977