目的 探讨脑血栓片联合阿替普酶治疗急性脑梗死的临床效果。方法 将西安高新医院于2021年3月—2023年6月期间收治的98例急性脑梗死患者，应用随机数字表法将98例急性脑梗死患者均分为对照组（49例）和治疗组（49例）。对照组患者采用注射用阿替普酶，剂量为0.9 mg/kg，最大剂量不超过90 mg，在治疗开始的前1 min先将10%的剂量以静脉推注的方式注入体内，剩余剂量则持续滴注60 min，治疗1次，溶栓完成后继续给予基础治疗。治疗组患者在对照组治疗基础上口服脑血栓片，6片/次，3次/d。两组均连续治疗14 d。观察两组的临床疗效，比较两组治疗前后改良日常生活能力指数（Barthel）评分、美国国立卫生研究院卒中量表（NIHSS）评分、同型半胱氨酸（Hcy）、白细胞介素-17（IL-17）、C反应蛋白（CRP）及血液流变学指标。结果 治疗后，治疗组总有效率为95.92%，显著高于对照组的81.63%（P＜0.05）。治疗后，两组改良Barthel评分均高于治疗前，而NIHSS评分均低于治疗前（P＜0.05）；治疗后，治疗组改良Barthel评分及NIHSS评分改善情况更加明显（P＜0.05）。治疗后，两组血清Hcy、IL-17、CRP水平均低于同组治疗前（P＜0.05）；治疗后，治疗组血清Hcy、IL-17、CRP水平改善情况更加明显（P＜0.05）。治疗后，两组各种切变速率下的全血黏度、纤维蛋白原、血浆黏度水平均低于治疗前（P＜0.05）；治疗后，治疗组各种切变速率下的全血黏度、纤维蛋白原、血浆黏度水平改善情况更加明显（P＜0.05）。结论 脑血栓片联合阿替普酶治疗急性脑梗死具有较好的临床效果，可改善患者的神经功能受损情况及血液高凝状态，提高患者独立生活能力，并能有效降低血清Hcy水平及机体的炎症反应，且安全性较好。

Objective To explore the clinical efficacy of Naoxueshuan Tablets combined with ateplase in treatment of acute cerebral infarction. Methods 98 Patients with acute cerebral infarction admitted to Xi’an Gaoxin Hospital from March 2021 to June 2023 were divided into control group (49 cases) and treatment group (49 cases) by random number table method. Patients in the control group were given Alteplase for injection, the dosage was 0.9 mg/kg, with the maximum dosage not exceeding 90 mg, and 10% of the dosage was injected intravenously 1 min before the start of treatment, and the remaining dosage was injected continuously for 60 min, treated once, and basic treatment was continued after completion of thrombolysis. Patients in the treatment group were po administered with Naoxueshuan Tablets on the basis of the control group, 6 tablets/time, three times daily. Both groups were treated continuously for 14 d. The clinical effects of the two groups were observed, and the Barthel scores, NIHSS scores, homocysteine (Hcy), interleukin-17 (IL-17), C-reactive protein (CRP) and hemorheology were compared between two groups before and after treatment. Results After treatment, the total effective rate of treatment group was 95.92%, which was significantly higher than that of control group (81.63%, P < 0.05). After treatment, the modified Barthel score in both groups was higher than before treatment, but the NIHSS score was lower than before treatment (P < 0.05). After treatment, the modified Barthel score and NIHSS score were significantly improved in treatment group (P < 0.05). After treatment, the levels of serum Hcy, IL-17, and CRP in 2 groups were lower than before treatment (P < 0.05). After treatment, the levels of serum Hcy, IL-17, and CRP in treatment group were significantly improved (P < 0.05). After treatment, the levels of whole blood viscosity, fibrinogen, and plasma viscosity under various shear rates were lower than before treatment (P < 0.05). After treatment, the levels of whole blood viscosity, fibrinogen and plasma viscosity were significantly improved under various shear rates in treatment group (P < 0.05). Conclusion Naoxueshuan Tablets combined with alteplase has good clinical efficacy in treatment of acute cerebral infarction, and can improve the neurological impairment and blood hypercoagulability of patients, and can improve the independent living ability of patients, which can effectively reduce the serum Hcy level and the inflammatory response with good safety.

R971

陕西省科学技术研究发展计划（2020JM3068）