目的 探讨天丹通络胶囊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2021年3月—2023年2月在如皋市人民医院就诊的100例急性脑梗死患者，按照随机数字表法将所有患者分为对照组和治疗组，每组各50例。对照组给予注射用阿替普酶，剂量0.9 mg/kg（不超过50 mg），先静脉滴注剂量的10%，剩余的90%静脉滴注60 min，治疗1次，溶栓完成后继续给予基础治疗。治疗组在对照组基础上口服天丹通络胶囊，5粒/次，3次/d。两组连续治疗2周后统计疗效。观察两组的临床疗效，比较两组患者的美国国立卫生研究院卒中量表（NIHSS）评分、超声指标和血清指标。结果 治疗后，治疗组的总有效率94.00%明显高于对照组的总有效率80.00%（P＜0.05）。治疗后，两组的NIHSS评分均显著降低（P＜0.05），治疗组NIHSS评分明显低于对照组（P＜0.05）。治疗后，两组的脑血管储备（CVR）、屏气指数（BHI）显著升高，病灶最长直径显著降低（P＜0.05）；治疗组的CVR、BHI高于对照组，病灶最长直径低于对照组（P＜0.05）。治疗后，两组的血清神经元特异性烯醇化酶（NSE）、正五聚蛋白3（PTX3）、脂蛋白相关磷脂酶A2（Lp-PLA2）水平均低于治疗前（P＜0.05）；治疗后，治疗组的血清NSE、PTX3、Lp-PLA2水平低于对照组，差异有统计学意义（P＜0.05）。结论 天丹通络胶囊联合注射用阿替普酶可提高急性脑梗死的临床疗效，能改善神经功能，提高脑血流灌注，可能与减轻神经细胞炎性损伤有关。

Objective To investigate the clinical effect of Tiandan Tongluo Capsules combined with Alteplase for injection in treatment of acute cerebral infarction. Methods Patients (100 cases) with acute cerebral infarction in the People’s Hospital of Rugao from March 2021 to February 2023 were divided into control and treatment groups according to the random number table method, and each group had 50 cases. Patients in the control group were given with Alteplase for injection, 0.9 mg/kg (not more than 50 mg). First, 10% of the dose was injected intravenously, and the remaining 90% was injected intravenously for 60 min, treated once, and basic treatment was continued after completion of thrombolysis. Patients in the treatment group were po administered with Tiandan Tongluo Capsules on the basis of the control group, 5 grains/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, and NIHSS scores, ultrasound indicators, and serum indicators in two groups were compared. Results After treatment, the total effective rate of 94.00% in the treatment group was significantly higher than that of 80.00% in the control group (P < 0.05). After treatment, NIHSS score of two groups was significantly decreased (P < 0.05), and the NIHSS score of the treatment group was significantly lower than that of the control group (P< 0.05). After treatment, CVR and BHI in two groups were significantly increased, but the longest lesion diameter in two groups was significantly decreased (P < 0.05). CVR and BHI in the treatment group were higher than those in the control group, but longest lesion diameter in the treatment group was lower than that in the control group (P < 0.05). After treatment, the serum levels of NSE, PTX3, and Lp-PLA2 in two groups were significantly decreased (P < 0.05). After treatment, the serum levels of NSE, PTX3, and Lp-PLA2 in the treatment group were lower than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion Tiantan Tongluo Capsules combined with Alteplase for injection can improve the therapeutic effect of acute cerebral infarction, improve nerve function and cerebral blood flow perfusion, which may be related to reducing inflammatory injury of nerve cells.

R971

如皋市科技攻关计划项目[SRG(22)1072]