目的 探讨通脉颗粒联合丁苯酞治疗急性脑梗死的临床效果。方法 选取2016年3月-2019年3月朝阳市第二医院收治的急性脑梗死患者120例，随机分成对照组（60例）和治疗组（60例）。对照组静脉滴注丁苯酞氯化钠注射液，25 mg/次，2次/d，缓慢滴注≥ 50 min，两次给药间隔≥ 6 h。治疗组在对照组基础上口服通脉颗粒，10 g/次，3次/d。两组均连续治疗2周。观察两组患者临床疗效，同时比较治疗前后两组患者美国国立卫生研究院卒中量表（NIHSS）、改良Barthel指数（MBI）评分、血小板最大聚集率（MAR）值、血浆纤维蛋白原（FIB）和D-二聚体（D-D）水平，脑血流动力学参数及血管内皮生长因子（VEGF）、金属基质蛋白酶-9（MMP-9）、神经元特异性烯醇化酶（NSE）和髓鞘碱性蛋白（MBP）水平。结果 治疗后，对照组和治疗组临床有效率分别为80.00%和93.33%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者NIHSS评分均显著低于治疗前（P<0.05），而MBI评分均显著升高（P<0.05），且治疗组NIHSS、MBI评分的改善程度均显著优于对照组（P<0.05）。治疗后，两组患者MAR值及血浆FIB、D-D水平均显著降低（P<0.05），且治疗组以上指标的改善后水平明显低于对照组（P<0.05）。治疗后，两组患者患侧大脑中动脉Vs、Vm值较治疗前均显著升高（P<0.05），而PI值则均显著降低（P<0.05），且治疗组患侧大脑中动脉血流动力学参数值的改善效果较对照组同期更明显（P<0.05）。治疗后，两组患者血清VEGF、MMP-9、NSE、MBP水平均较治疗前显著下降（P<0.05），且治疗组上述血清学指标水平降低更显著（P<0.05）。结论 通脉颗粒联合丁苯酞治疗急性脑梗死的疗效切实可靠，能明显抑制患者体内血栓形成，改善脑血流动力学，促进新生血管形成，减轻脑水肿，促进神经功能恢复，改善患者日常生活能力。

Objective To investigate the clinical effect of Tongmai Granules combined with butylphthalide in treatment of acute cerebral infarction. Methods Patients (120 cases) with acute cerebral infarction in Chaoyang Second Hospital from March 2016 to March 2019 were randomly divided into control (60 cases) and treatment (60 cases) groups. Patients in the control group were iv administered with Butylphthalide and Sodium Chloride Injection, 25 mg/time, twice daily, the drip time was not less than 50 min, and the interval time between two administration was not less than 6 h. Patients in the treatment group were po administered with Tongmai Granules on the basis of the control group, 10 g/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the NIHSS scores, MBI scores, MAR value, FIB and D-D content in plasma, hemodynamic parameters, and GF, MMP-9, NSE and MBP levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 80.00% and 93.33% respectively, and there were differences between two groups (P < 0.05). After treatment, the NIHSS scores in two groups were significantly decreased (P < 0.05), but the MBI scores were significantly increased (P < 0.05), and these scores in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the MAR value, FIB and D-D content in plasma in two groups were significantly decreased (P < 0.05), and these indicators in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the Vs and Vm value of cerebral artery in two groups was significantly increased (P < 0.05), but the PI value was significantly decreased (P < 0.05), and the hemodynamic parameters of cerebral artery in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the serum levels of VEGF, MMP-9, NSE and MBP in two groups were significantly decreased (P < 0.05), and these indexes in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Tongmai Granules combined with butylphthalide in treatment of acute cerebral infarction is effective and reliable, which can significantly inhibit thrombosis, improve cerebral hemodynamics, promote neovascularization, reduce cerebral edema, promote recovery of neurological function, and improve patients' daily living ability.

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