目的 探究清开灵注射液联合己酮可可碱治疗急性脑梗死的临床效果。方法 选取2023年1月—2024年3月在武汉市中医医院诊治的急性脑梗死患者130例，随机分成对照组和治疗组，每组各65例。对照组患者静脉滴注己酮可可碱注射液，1次/d，0.2 g溶解于100 mL生理盐水，2 h内输注完毕。治疗组患者在静脉滴注己酮可可碱之外加用清开灵注射液静脉输注，每日2次，每次将20 mL药液与100 mL生理盐水混合后静脉输注。所有患者持续用药14 d。对比两组患者的临床效果，统计分析治疗前后中医证候评分、NIHSS量表（美国国立卫生研究院卒中量表）及mRS量表（改良Rankin量表）和扩散加权成像阿尔伯塔卒中项目早期CT评分（DWI-ASPECTS），血清脂蛋白磷脂酶A2（Lp-pLA2）、成纤维细胞生长因子4（FGF4）和神经元PAS结构域蛋白4（NPASDP4）水平。结果 治疗后，治疗组患者总有效率（95.38%）显著高于对照组（83.08%），组间差异具有统计学意义（P＜0.05）。治疗后，两组中医证候积分、NIHSS评分、mRS评分均显著降低（P＜0.05），DWI-ASPECTS评分均明显提升（P＜0.05）；治疗组患者各评分改善幅度较对照组改善更明显（P＜0.05）。治疗后，治疗组与对照组Lp-PLA2、FGF4及NPASDP4血清水平均显著降低（P＜0.05），其中治疗组各指标降幅较对照组改善更显著（P＜0.05）。随访分析结果显示，对照组患者不良预后率为26.15%，显著高于治疗组的10.77%（P＜0.05）。结论 清开灵联合己酮可可碱治疗急性脑梗死疗效显著，不仅能够显著改善患者临床症状、脑部缺血范围及神经缺损程度，还可通过改善脑微循环与抑制神经炎症协同作用提升治疗效率。

Objective Exploring the therapeutic effect of Qingkailing Injection combined with pentoxifylline in treatment of acute cerebral infarction. Methods A total of 130 patients with acute cerebral infarction diagnosed and treated in Wuhan Hospital of Traditional Chinese Medicine from January 2023 to March 2024 were randomly divided into control group and treatment group, with 65 patients in each group. Patients in control group was given Pentoxifylline Injection, once daily, 0.2 g dissolved in 100 mL normal saline, and the infusion was completed within 2 h. Patients in treatment group were given intravenous infusion of Qingkailing Injection, in addition to intravenous infusion of pentoxifylline, twice daily, and each time 20 mL of liquid medicine was mixed with 100 mL of normal saline before intravenous infusion. All patients were treated for 14 d. After treatment, the clinical evaluations were evaluated, and the scores of TCM symptom, NIHSS, mRS, and DWI-ASPECTS, the levels of serum Lp-pLA₂, FGF4 and NPAS4, and prognosis within 3 months in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group (95.38%) was significantly higher than that of the control group (83.08%), and the difference was statistically significant (P < 0.05). After treatment, TCM syndrome scores, NIHSS scores and mRS Scores in both groups were significantly decreased (P < 0.05), while DWI-ASPECTS scores were significantly increased (P < 0.05). The improvement of all indexes in the treatment group was more obvious than that in the control group (P < 0.05). After treatment, the serum levels of Lp-PLA2, FGF4 and NPASDP4 in the treatment group and the control group were significantly decreased (P < 0.05), and the reduction of each index in the treatment group was more significant than that in the control group (P < 0.05). The results of follow-up analysis showed that the adverse prognosis rate of the control group was 26.15%, which was significantly higher than that of the treatment group (10.77%) (P < 0.05). Conclusion Qingkailing Injection combined with pentoxifylline is effective in the treatment of acute cerebral infarction, which can not only significantly improve the clinical symptoms, cerebral ischemia range and nerve defect degree of patients, but also improve the therapeutic efficiency by improving the synergistic effect of cerebral microcirculation and inhibiting neuroinflammation.

R971

老年脑健康中医药防护技术与新产品研发教育部工程研究中心开放基金（ZY2021M047）；武汉市中医药科研项目（WZ24M01）