目的 探讨天丹通络胶囊联合银杏达莫和依达拉奉治疗急性脑梗死的临床疗效。方法 选取2015年5月-2016年5月在安康市人民医院接受治疗的急性脑梗死患者88例，根据治疗方案的差别分为对照组和治疗组，每组各44例。对照组患者静脉滴注银杏达莫注射液，20 mL加入生理盐水250 mL，2次/d；同时静脉滴注依达拉奉注射液，30 mg加入生理盐水100 mL，2次/d。治疗组在对照组的基础上口服天丹通络胶囊，5粒/次，3次/d。两组患者均连续治疗2周。观察两组的临床疗效，记录两组治疗前后神经功能缺损（NIHSS）评分和Barthel指数的变化情况，同时比较两组患者血浆黏度、全血黏度、血细胞比容（HCT）、红细胞聚集指数（RF）、超敏C-反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、基质金属蛋白酶-9（MMP-9）、血管内皮生长因子（VEGF）、脑源性神经营养因子（BDNF）、内皮素-1（ET-1）和NO水平。结果 治疗后，对照组和治疗组的总有效率分别为81.82%和95.45%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者NIHSS评分显著降低，Barthel指数升高，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组NIHSS评分和Barthel指数的变化程度优于对照组（P<0.05）。治疗后，两组患者血浆黏度、全血黏度、HCT和RF均较治疗前显著降低，同组治疗前后差异有统计学意义（P<0.05）；且治疗组血液流变学指标的降低程度优于对照组（P<0.05）。治疗后，两组患者hs-CRP、TNF-α、MMP-9和ET-1水平均显著降低，NO、BDNF和VEGF水平显著升高，同组治疗前后差异有统计学意义（P<0.05）；且治疗组这些血清学指标的改善程度优于对照组，两组比较差异具有统计学意义（P<0.05）。结论 天丹通络胶囊联合银杏达莫和依达拉奉治疗急性脑梗死可明显提高临床疗效，改善患者血液流变学状态，并可降低血清炎性因子水平，具有一定的临床推广应用价值。

Objective To study the clinical effect of Tiandan Tongluo Capsules combined with ginkgo leaf extract and dipyridamole and edaravone in treatment of acute cerebral infarction (ACI). Methods Patients (88 cases) with ACI in Ankang People's Hospital from May 2015 to May 2016 were enrolled in this study. According to the different treatment plans, patients were divided into control group and treatment group, and each group had 44 cases. The patients in the control group were iv administered with Ginkgo Leaf Extract and Dipyridamole Injection, 20 mL added into 250 mL normal saline, twice daily; And they were iv administered with Edaravone Injection, 30 mg added into 100 mL normal saline, twice daily. The 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. The patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, the changes of NIHSS scores and Barthel indexes were recorded before and after treatment in two groups, and plasma viscosity, whole blood viscosity, HCT, RF, and the expression levels of hs-CRP, TNF-α, MMP-9, VEGF, BDNF, ET-1, and NO in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 81.82% and 95.45%, respectively, and there were differences between two groups (P<0.05). After treatment, NIHSS scores in two groups were significantly decreased, Barthel indexes were increased, and the difference was statistically significant in the same group (P<0.05). And the changes of NIHSS scores and Barthel indexes in the treatment group were better than those in the control group (P<0.05). After treatment, plasma viscosity, whole blood viscosity, HCT, and RF in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the decrease degree of these blood rheology indexes in the treatment group was significantly better than those in the control group (P<0.05). After treatment, hs-CRP, TNF-α, MMP-9, and ET-1 levels in two groups were significantly decreased, the levels of NO, BDNF, and VEGF were increased, and the difference was statistically significant in the same group (P<0.05). And these serological indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Tiandan Tongluo Capsules combined with ginkgo leaf extract and dipyridamole and edaravone can improve the clinical efficacy in treatment of ACI, and can significantly improve blood rheology state and reduce the serum inflammatory factors levels, which has a certain clinical application value.