目的 探讨天智颗粒联合长春西汀注射液治疗脑梗死恢复期的临床疗效。方法 选择2019年9月—2020年9月在河南省直第三人民医院治疗的82例脑梗死恢复期患者，根据入院先后分为对照组（41例）和治疗组（41例）。对照组静脉滴注长春西汀注射液，初始剂量20 mg加入生理盐水500 mL，根据病情增至30 mg，1次/d。治疗组在对照组基础上口服天智颗粒，5 g/次，3次/d。两组均治疗14 d。观察两组患者临床疗效，比较治疗前后两组患者临床症状改善时间，NIHSS、FMA、ADL和MSS评分，血清泛素羧基末端水解酶-1（UCH-L1）、白细胞介素-23（IL-23）、神经元特异性烯醇化酶（NSE）、促血管生成素Ⅱ（Ang-2）和血管内皮生长因子（VEGF）水平。结果 经治疗，对照组总有效率为80.49%，显著低于治疗组的97.56%（P<0.05）。治疗后，治疗组症状改善时间均早于对照组（P<0.05）。经治疗，两组NIHSS评分、FMA评分、ADL评分、MSS评分均显著改善（P<0.05），且治疗组改善最明显（P<0.05）。经治疗，两组患者血清UCH-L1、IL-23和Ang-2水平显著降低，而NSE和VEGF水平显著升高（P<0.05），且治疗组血清学指标水平明显好于对照组（P<0.05）。结论 天智颗粒联合长春西汀注射液治疗脑梗死恢复期可有效改善患者临床症状，促进脑神经功能及血清细胞因子的改善，有利于增强患者生活活动能力和运动功能。

Objective To investigate the clinical effect of Tianzhi Granules combined with vinpocetine in treatment of cerebral infarction in convalescent stage. Methods Patients (82 cases) with cerebral infarction in convalescent stage in the Third People's Hospital of Henan Province from September 2019 to September 2020 were divided into control (41 cases) and treatment (41 cases) groups based on visiting order. Patients in the control group were iv administered with Vinpocetine Injection, the initial dose was 20 mg added into 500 mL normal saline, and increased to 30 mg according to patient's condition, once daily. Patients in the treatment group were po administered with Tianzhi Granules on the basis of the control group, 5 g/time, three times daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the improvement time of clinical symptoms, the scores of NIHSS, FMA, ADL and MSS, and the serum levels of UCH-L1, IL-23, Ang-2, NSE, and VEGF in two groups before and after treatment were compared. Results After treatment, the effective rate in the control group was 80.49%, which was significantly lower than 97.56% in the treatment group (P<0.05). After treatment, the improvement time of clinical symptoms in the treatment group was significantly earlier than that in the control group (P<0.05). After treatment, NIHSS score, FMA score, ADL score and MSS score in two groups were significantly improved (P<0.05), and especially in the treatment group (P<0.05). After treatment, the serum levels of UCH-L1, IL-23 and Ang-2 in two groups were significantly decreased, while the levels of NSE and VEGF were significantly increased (P<0.05), and the level of serum indexes in the treatment group was significantly better than that in the control group (P<0.05). Conclusion Tianzhi Granules combined with vinpocetine in treatment of cerebral infarction in convalescent stage can effectively improve the clinical symptoms, promote the improvement of brain nerve function and serum cytokines, which is conducive to enhance the living activity and motor function of patients.

R971

河南省医学科技攻关计划项目（201702177）