目的 探讨苦碟子注射液联合阿替普酶治疗急性脑梗死临床疗效。方法 选取2020年7月—2022年7月郑州市第三人民医院收治的112例急性脑梗死患者，随机分为对照组和治疗组，每组各56例。对照组患者静脉注射注射用阿替普酶，0.9 mg/kg，最大剂量不超过90 mg，在1 min内静脉推注总药量的10%，剩下的90%在1 h内静脉泵入。在对照组基础上，治疗组静脉滴注苦碟子注射液，40 mL/次加入生理盐水300 mL，1次/d。两组治疗14 d。观察两组患者临床疗效，比较治疗前后两组患者症状改善时间、神经功能受损程度（NIHSS）评分、氧化应激水平，血清炎性因子白细胞介素-6（IL-6）、胱抑素C（CysC）、肿瘤坏死因子-α（TNF-α）和同型半胱氨酸（Hcy）水平，及不良反应情况。结果 治疗后，治疗组患者临床有效率为91.07%，明显高于对照组（71.43%，P＜0.05）。治疗后，治疗组症状改善时间均早于对照组（P＜0.05）。治疗后，两组患者NIHSS评分指标均明显下降（P＜0.05），且治疗组NIHSS评分指标明显低于对照组（P＜0.05）。治疗后，两组患者超氧化物歧化酶（SOD）和谷胱甘肽过氧化物酶（CSH-Px）指标明显升高，而丙二醛（MDA）指标明显降低（P＜0.05），且治疗组氧化应激水平明显好于对照组（P＜0.05）。治疗后，两组患者血清炎性因子IL-6、Cys-C、TNF-α、Hcy水平明显降低（P＜0.05），且治疗组明显均低于对照组（P＜0.05）。治疗后，治疗组不良反应总发生率为5.36%，明显低于对照组（10.71%，P＜0.05）。结论 阿替普酶联合苦碟子注射液治疗急性脑梗死疗效确切，对脑神经功能损伤程度及氧化应激反应改善明显，并能降低机体炎性因子水平，且安全性良好。

Objective To investigate the clinical study of Kudiezi Injection combined with alteplase in treatment of acute ischemic stroke. Methods Patients (112 cases) with acute ischemic stroke in Zhengzhou Third People’s Hospital from July 2020 to July 2022 were randomly divided into control and treatment group, and each group had 56 cases. Patients in the control group was iv administered with Alteplase for injection, 0.9 mg/kg, the maximum dose was no more than 90 mg, 10% of the total dose was injected intravenously within 1 min, and the remaining 90% was pumped intravenously within 1 h. Patients in the treatment group were iv administered with Kudiezi Injection on the basis of the control group, 40 mL/time added into normal saline 300 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical evaluation was evaluated, and the improvement time of symptom, NIHSS scores, oxidative stress response level, the levels of serum inflammatory factor IL-6, Cys-C, TNF-α and Hcy, and adverse reaction in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 91.07%, which was significantly higher than that of the control group (71.43%, P < 0.05). After treatment, the improvement time of symptom in the treatment group was earlier than that in the control group (P < 0.05). After treatment, the NIHSS score index in two groups was significantly decreased, and which in the treatment group was significantly lower than that of the control group (P < 0.05). After treatment, the indexes of SOD and CSH-Px in two groups were significantly increased, while the index of MDA was significantly decreased (P < 0.05), and the level of oxidative stress in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the levels of serum inflammatory factors IL-6, Cys-C, TNF-α and Hcy in two groups were significantly decreased (P < 0.05), and which in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the total incidence of adverse reactions in the treatment group was 5.36%, which was significantly lower than that in the control group (10.71%, P < 0.05). Conclusion Ateplase combined with Kudiezi Injection is effective in the treatment of acute cerebral infarction, which can significantly improve the degree of brain nerve function injury and oxidative stress response, and can reduce the level of inflammatory factors, and the safety is good.

R971

河南省医学科技攻关项目（182102310172）