目的 观察丹参川芎嗪注射液联合长春西汀治疗急性脑梗死的临床疗效,为临床合理联合用药提供参考.方法 选取十堰市太和医院2012年11月—2014年10月收治的急性脑梗死患者326例,随机分为对照组和治疗组,各163例.两组患者均给予常规治疗,对照组在常规治疗的基础上静滴长春西汀注射液30 mg,以500 mL 0.9%生理盐水稀释,1次/d;治疗组在对照组的基础上静滴丹参川芎嗪注射液40 mg,以500 mL 0.9%生理盐水稀释,1次/d,14 d为1个疗程,两组均治疗1个疗程.计算治疗前后患者日常生活能力(ADL)及欧洲卒中量表(ESS)评分,观察两组的临床疗效,并记录两组治疗前及治疗1、5、9、14 d的脑电图棘波波幅(EEG)和局部脑血流(rCBF),并测定两组治疗前后的血液流变学指标.结果 经14 d治疗后,治疗组的ESS评分降低、ADL提高,总有效率达92%,与对照组比较差异有统计学意义(P< 0.05);两组的EEG及rCBF均逐步恢复和增高,同组治疗前后差异有统计学意义(P< 0.05),且治疗组的EEG及rCBF改善程度均优于对照组,两组比较差异有统计学意义(P< 0.05);两组血液流变学指标在治疗后有不同程度的降低,同组治疗前后比较差异均有统计学意义(P< 0.05),治疗组的总胆固醇、低密度脂蛋白胆固醇、纤维蛋白、全血高切黏度、全血低切黏度、血小板集聚率等血液流变学指标降低更加明显,与对照组比较差异有统计学意义(P< 0.05).结论 丹参川芎嗪注射液联合长春西汀治疗急性脑梗死能显著增加患者rCBF、缩短EEG恢复至正常水平的时间,明显降低ESS评分,改善患者血液流变学效应,对促进患者神经功能恢复及提高生活质量有确切的临床疗效,有一定的临床推广价值.

Objective To observe the clinical effect of Danshen Chuanxiongqin Injection combined with vinpocetine in treatment of acute cerebral infarction, in order to provide reference for the clinical reasonable drug combination. Methods The patients with acute cerebral infarction (326 cases) of Shiyan Taihe Hospital from November 2012 to October 2014 were randomly divided into control and treatment groups, and each group had 163 cases. The patients in two groups were given conventional therapy. On the basis of conventional therapy, the patients in the control group were iv administered with Vinpocetine Injection (30 mg diluted with 500 mL physiological saline), once daily. On the basis of the contro group, the patients in the treatment group were iv administered with Danshen Chuanxiongqin Injection (40 mg diluted with 500 mL physiological saline), once daily. One course had 14 d. The patients in two groups were treated for one course. Activity of daily living (ADL) and the European stroke scale (ESS) were calculated. The clinical effect, electroencephalogram (EEG), and regional cerebral blood flow (rCBF) were observed before and 1, 5, 9, 14 d after treatment. Hemodynamic indexes were determined before and after treatment. Results After 14 d treatment, ESS scores in treatment group decreased and ADL increased. The total effective rate in treatment group was 92%, and there was statistically significant difference compared with those of control group (P <0.05). EEG and rCBF were improved more than those of control group with significant difference (P <0.05). And there was statistically significant difference between those of both groups before and after treatment (P <0.05). Hemodynamic indexes in both groups decreased to different extent after treatment, and there was statistically significant difference between those of both groups before and after treatment (P <0.05). Total cholesterol, low density lipoprotein cholesterol, protein fiber, high blood viscosity, low blood viscosity, platelet aggregation rate, and other indexes decreased more obviously, and there were statistically significant differences compared with those of control group (P <0.05). Conclusion Danshen Chuanxiongqin Injection combined with vinpocetine in treatment of acute cerebral infarction can significantly increased the time of rCBF returning to normal levels, and shorten the time of EEG returning to normal levels. And it can significantly lower ESS scores, improve hemodynamic indexes, promote neurological function recovery and has clinical effect of improving the quality of life, which is worth clinical promotion.