目的 探讨小牛血清去蛋白注射液联合阿替普酶治疗急性脑梗死的临床效果。方法 选取2015年3月-2018年3月海南医学院第二附属医院收治的85例急性脑梗死患者，随机分为对照组（42例）和治疗组（43例）。对照组给予注射用阿替普酶，0.9 mg/kg（最大剂量为90 mg），在最初1 min内静脉快速推注总剂量的10%，剩余90%在>1 h内持续静脉滴注完毕。治疗组在对照组治疗基础上静脉滴注小牛血清去蛋白注射液，30 mL加入0.9%氯化钠溶液50 mL中均匀混合后给药，滴速为2 mL/min，1次/d。两组均连续治疗2周。观察两组的临床疗效，比较两组治疗前后血栓弹力图指标、中性粒细胞/淋巴细胞比值（NLR）、美国国立卫生研究院卒中量表（NIHSS）评分、血清学指标的变化情况。结果 治疗后，对照组和治疗组的总有效率分别是76.2%、93.0%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组血栓弹力图血细胞凝集块形成时间（K值）、凝血反应时间（R值）均显著升高，但最大血块强度（MA值）、血细胞凝集块形成速率（α角）和凝血综合指数（CI值）均显著降低，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组K值、R值均显著高于对照组，但MA值、α角和CI值均显著低于对照组，两组比较差异具有统计学意义（P<0.05）。两组外周血NLR值和血清基质金属蛋白酶（MMP）-9、8-羟基脱氧鸟苷（8-OHdG）、NO水平较治疗前均显著下降，同组治疗前后比较差异有统计学意义（P<0.05）。治疗后，治疗组外周血NLR值、血清基质金属蛋白酶（MMP）-9、8-羟基脱氧鸟苷（8-OHdG）、NO水平均显著低于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，两组NIHSS评分、神经元特异性烯醇化酶（NSE）水平均显著降低，但血清脑源性神经营养因子（BDNF）水平均显著升高，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组NIHSS评分、NSE水平均显著低于对照组，BDNF水平高于对照组，两组比较差异具有统计学意义（P<0.05）。结论 小牛血清去蛋白注射液联合阿替普酶治疗急性脑梗死具有较好的临床疗效，可明显改善患者凝血-纤溶状态及微循环，减轻炎性损伤和神经功能损伤，具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Deproteinised Calf Blood Serum Injection combined with alteplase in treatment of acute cerebral infarction. Methods Patients (85 cases) with acute cerebral infarction in Second Affiliated Hospital of Hainan Medical University from March 2015 to March 2018 were randomly divided into control (42 cases) and treatment (43 cases) groups. Patients in the control group were given Alteplase for Injection, 0.9 mg/kg (maximum dosage was 90 mg), 10% of the total amount was pushed intravenous injection rapidly within the first 1 min, and the remaining 90% were completed by continuous intravenous drip longer than 1 h. Patients in the treatment group were iv administered with Deproteinised Calf Blood Serum Injection on the basis of the control group, 30 mL added into 0.9% normal saline 50 mL, and the dripping speed was 2 mL/min, once daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the changes of thromboelastogram indexes, NLR, NIHSS score, and serological indicators in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 76.2% and 93.0%, and there were differences between two groups (P < 0.05). After treatment, K value and R value of thromboelastogram were increased, but MA value, α angle and CI value were decreased, and there were differences in the same group (P < 0.05). After treatment, K value and R value in the treatment group were higher than those in the control group, but MA value, α angle and CI value were lower than those in the control group, and there were differences between two groups (P < 0.05). After treatment, NLR, MMP-9, 8-OHdG, and NO were decreased, and there were differences in the same group (P < 0.05). After treatment, NLR, MMP-9, 8-OHdG, and NO in the treatment group were lower than those in the control group, and there were differences between two groups (P < 0.05). After treatment, NIHSS score and NSE were decreased, but BDNF were increased, and there were differences in the same group (P < 0.05). After treatment, NIHSS score and NSE in the treatment group were lower than those in the control group, but BDNF was higher than those in the control group, and there were differences between two groups (P < 0.05). Conclusion Deproteinised Calf Blood Serum Injection combined with alteplase has significant clinical effect in treatment of acute cerebral infarction, and can significantly improve the coagulation-fibrinolysis state and microcirculation, and alleviate the inflammatory injury and nerve function injury, which has a certain clinical application value.