目的 探讨天丹通络片联合丁苯酞氯化钠注射液治疗急性脑梗死的临床疗效。方法 选取2020年8月—2022年5月首都医科大学附属北京友谊医院平谷医院收治的86例急性脑梗死患者，按随机数字表法将所有患者分为对照组和治疗组，每组各43例。对照组静脉滴注丁苯酞氯化钠注射液，100 mL/次，2次/d。治疗组患者在对照组治疗基础上口服天丹通络片，5片/次，3次/d。两组疗程均为14 d。观察两组的临床疗效，比较治疗前后两组美国国立卫生研究院卒中量表（NIHSS）评分、血小板参数[血小板分布宽度（PDW）、平均血小板体积（MPV）]，凝血指标[纤维蛋白原（FIB）、D-二聚体（D-D）]，外周血血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）及血清同型半胱氨酸（HCY）、超敏C反应蛋白（hs-CRP）水平。结果 治疗后，治疗组总有效率是95.35%，较对照组的81.40%显著提高（P＜0.05）。治疗后，两组NIHSS评分均显著降低（P＜0.05）；治疗后，治疗组NIHSS评分显著低于对照组（P＜0.05）。治疗后，两组PDW、MPV和血浆FIB、D-D水平均显著降低（P＜0.05）；且治疗后，治疗组PDW、MPV和血浆FIB、D-D水平均显著低于对照组（P＜0.05）。治疗后，两组外周血PLR、NLR和血清Hcy、hs-CRP水平均显著下降（P＜0.05）；且治疗后，治疗组外周血PLR、NLR和血清Hcy、hs-CRP水平均显著低于对照组（P＜0.05）。结论 天丹通络片联合丁苯酞氯化钠注射液治疗急性脑梗死的整体效果确切，可减轻患者神经功能缺损、促进侧支循环建立，并能进一步改善血液高凝状态及下调外周血PLR、NLR和血清HCY、hs-CRP水平。

Objective To investigate the clinical effect of Tiandan Tongluo Tablets combined with butylphthalide in treatment of acute cerebral infarction. Methods A total of 86 patients with acute cerebral infarction admitted to Pinggu Hospital, Beijing Friendship Hospital Affiliated to Capital Medical University from August 2020 to May 2022 were selected and divided into control group and treatment group according to random number table method, with 43 cases in each group. Patients in the control group were iv administered with Butylphthalide and Sodium Chloride Injection, 100 mL/time, twice daily. Patients in the treatment group were po administered with Tiandan Tongluo Tablets on the basis of the control group, 5 tablets/time, three times daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the National Institutes of Health Stroke Scale (NIHSS) score, regional leptomeningial collateral circulation (rLMC) score, platelet parameters [platelet distribution width (PDW), mean platelet volume (MPV)], coagulation indexes [fibrinogen (FIB), D-dimer (D-D)], peripheral blood platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), serum homocysteine (HCY), high sensitive C-reactive protein (hs-CRP) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 95.35%, which was significantly higher than that of the control group (81.40%) (P < 0.05). After treatment, NIHSS scores in both groups were significantly decreased (P < 0.05). After treatment, the NIHSS score in the treatment group was significantly lower than that in control group (P < 0.05). After treatment, the levels of PDW, MPV, plasma FIB and D-D were significantly decreased in both groups (P <0.05). After treatment, the levels of PDW, MPV, plasma FIB and D-D in the treatment group were significantly lower than those in control group (P < 0.05). After treatment, the levels of peripheral blood PLR, NLR and serum HCY and hs-CRP in two groups were significantly decreased (P < 0.05). After treatment, the levels of peripheral blood PLR, NLR, serum HCY and hs-CRP in treatment group were significantly lower than those in control group (P < 0.05). Conclusions Tiandan Tongluo Tablets combined with butylphthalide has a definite overall effect in treatment of acute cerebral infarction, and can alleviate the neurological impairment, promote the establishment of collateral circulation, further improve the blood hypercoagulability, and lower the levels of PLR, NLR, HCY and hs-CRP in peripheral blood.

R971