目的 观察曲克芦丁脑蛋白水解物联合阿替普酶治疗急性脑梗死的临床效果。方法 选择2019月12—2021年12月南阳市中心医院接收的106例急性脑梗死患者，随机分为对照组和治疗组，每组各53例。对照组予以注射用阿替普酶0.9 mg/kg，在超声引导下给药，先静推10%，60 s内结束，剩余静脉滴注，60 min内结束，依照超声监测结果可适当调整剂量，治疗1次，溶栓后继续予以常规治疗至2周。治疗组在对照组基础上静脉滴注曲克芦丁脑蛋白水解物注射液，10 mL融于250 mL生理盐水混匀，1次/d，持续应用2周。观察两组患者临床疗效，比较治疗前后两组患者美国国立卫生研究院脑卒中量表（NIHSS）和改良Rankin量表（MRS）评分，脑血流动力学指标平均血流速度（V_m）、舒张末期血流速度（V_d）和收缩期峰值血流速度（V_p）水平，以及膜联蛋白A2（Annexin A2）、同型半胱氨酸（Hcy）和血管内皮生长因子（VEGF）水平。结果 治疗后，治疗组临床总有效率（90.57%）较对照组（75.47%）明显升高（P＜0.05）；治疗后，两组NIHSS评分、MRS评分均较治疗前显著降低（P＜0.05），且治疗组较对照组降低更明显（P＜0.05）。治疗后，两组大脑中动脉（MCA）的Vm、Vd、Vp均较治疗前显著升高（P＜0.05），且治疗组较对照组升高更显著（P＜0.05）。治疗后，两组患者Annexin A2、VEGF水平均较治疗前明显升高，而Hcy水平均较治疗前明显降低（P＜0.05），且治疗组患者Hcy、Annexin A2、VEGF水平明显好于对照组（P＜0.05）。结论 曲克芦丁脑蛋白水解物联合阿替普酶治疗急性脑梗死可调节Annexin A2、Hcy、VEGF水平，改善脑血流动力学，发挥良好神经保护作用，改善疗效及预后。

Objective To observe the effect of troxerutin and cerebroprotein hydrolysate combined with alteplase in treatment of acute cerebral infarction.Methods Patients (106 cases) with acute cerebral infarction in Nanyang Central Hospital from December 2019 to December 2021 were randomly divided into control and treatment group, and each group had 53 cases. Patients in the control group were administered with Alteplase for injection, 0.9 mg/kg, 10% of the drug was injected intravenously within 60 s under the guidance of ultrasound, and the rest was iv administered with within 60 min, according to the results of ultrasound monitoring, the dosage could be adjusted appropriately, once treatment, and routine treatment continued to 2 weeks after thrombolysis. Patients in the treatment group were iv administered with Troxerutin and Cerebroprotein Hydrolysate Injection on the basis of the control group, 10 mL added into 250 mL normal saline, once daily, they were treated for 2 weeks. After treatment, the clinical evaluation was evaluated, the scores of NIHSS and MRS, the levels of cerebral hemodynamic indexes V_m, V_d and V_p, the Hcy, Annexin A2 and VEGF levels in two groups before and after treatment were compared. Results After treatment, the total clinical effective rate of the treatment group (90.57%) was significantly higher than that of the control group (75.47%) (P < 0.05); After treatment, the NIHSS score and MRS score of the two groups were significantly lower than those before treatment (P < 0.05), and the treatment group was significantly lower than that of the control group (P < 0.05). After treatment, the Vm, Vd and Vp of MCA in two groups were significantly higher than those before treatment (P < 0.05), and the increase in the treatment group was more significant than that in the control group (P < 0.05). After treatment, the levels of annexin A2 and VEGF in two groups were significantly higher than those before treatment, while the levels of Hcy were significantly lower (P < 0.05), and the levels of Hcy, annexin A2 and VEGF in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Troxerutin and cerebroprotein hydrolysate combined with alteplase in treatment of acute cerebral infarction can improve the levels of Annexin A2, Hcy and VEGF, cerebral hemodynamics, play a good neuroprotective effect, and improve the curative effect and prognosis.

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