目的 分析丁苯酞序贯疗法联合阿替普酶溶栓对急性脑梗死患者的治疗作用。方法 选择2021年1月—2023年12月在上海市第一人民医院嘉定医院诊治的急性脑梗死患者80例，以随机抽签法分为对照组和治疗组，每组各40例。对照组静脉滴注注射用阿替普酶，0.9 mg/kg，首先静脉推注药液总剂量的10%，60 s内推注完成，其余药液需1 h内静脉滴注完毕。在对照组基础上，治疗组静脉滴注丁苯酞注射液2周，25 mg/次，2次/d，患者病情稳定后口服丁苯酞软胶囊，0.2 g/次，3次/d。两组患者不间断用药3周。观察两组患者临床疗效，比较治疗前后两组患者血液流变学功能，凝血功能，神经功能缺损情况，认知功能、炎症反应和神经影像学功能。结果 治疗后，治疗组患者总有效率明显高于对照组（97.50% vs 80.00%，P＜0.05）。治疗后，两组患者血小板抑制率、凝血活酶时间（APTT）、凝血酶原时间（PT）、相对表观扩散系数值（rADC）水平明显升高，而血小板黏附率、全血黏度、红细胞沉降率、血浆纤维蛋白原（FIB）、血小板（PLT）、白细胞计数、中性粒细胞比率、C反应蛋白（CRP）、梗死灶体积则明显降低（P＜0.05），且治疗后治疗组这些指标明显好于对照组（P＜0.05）。治疗后，两组患者NIHSS评分明显低于治疗前，而MMSE各评分明显高于治疗前（P＜0.05），且治疗后治疗组NIHSS和MMSE各评分明显好于对照组（P＜0.05）。结论 丁苯酞序贯疗法与阿替普酶溶栓相结合，可改善急性脑梗死患者的神经功能、血流动力学与凝血功能状态，促使认知功能恢复，降低炎性反应。

Objective To analyze the effect of butylphthalide sequential therapy combined with alteplase in treatment of acute cerebral infarction. Methods Patients (80 cases) with acute cerebral infarction in Jiading Branch of Shanghai General Hospital from January 2021 to December 2023 were divided into control and treatment group by random draw, and each group had 40 cases. Patients in the control group were iv administered with Alteplase for injection, 0.9 mg/kg, first, 10% of the total dose was injected intravenously, and the bolus was completed within 60 s, and the rest medicine was injected intravenously within 1 h. Patients in the treatment group were iv administered with Butylphthalide Injection on the basis of the control group for 2 weeks, after the condition stabilized, they were po administered with Butylphthalide Soft Capsules, 0.2 g/time, three times daily. Patients in two groups were treated for 3 weeks. After treatment, the clinical evaluations were evaluated, the hemorheological function, coagulation function, neurological deficits, cognitive function, inflammatory response, neuroimaging function in two groups before and after treatment were compared. Results After treatment, the clinical effective rate in the treatment group was significantly higher than that in the control group (97.50% vs 80.00%, P < 0.05). After treatment, the platelet inhibition rate, APTT, PT, and rADC were significantly increased in two groups, while the platelet adhesion rate, whole blood viscosity, red blood cell sedimentation rate, FIB, PLT, white blood cell count, neutrophil ratio, CRP, and infarction volume were significantly decreased (P < 0.05), and the levels of these indicators in the treatment group were significantly better than those in the control group after treatment (P < 0.05). After treatment, the NIHSS scores in two groups were significantly lower than those before treatment, while the MMSE scores were significantly higher than those before treatment (P < 0.05). After treatment, the NIHSS and MMSE scores in the treatment group were significantly better than those of the control group (P < 0.05). Conclusions The combination of butylphthalide sequential therapy with alteplase thrombolysis can improve neurological function, hemodynamics and coagulation status in patients with acute cerebral infarction, promote the recovery of cognitive function, and reduce inflammatory response.

R971