目的 探寻倍他司汀联合替罗非班治疗超静脉溶栓时间窗急性脑梗死患者的疗效。方法 选取2024年10月—2025年10月滨州医学院烟台附属医院收治的102例超静脉溶栓时间窗急性脑梗死患者，按照随机数字表法分为对照组和治疗组，每组各51例。对照组给予盐酸替罗非班注射液，推注剂量0.4 μg/(kg·min)，持续3 min，总剂量≤1 mg，后以0.1 μg/(kg·min)滴注维持24 h。治疗组在对照组方案基础上静脉滴注盐酸倍他司汀氯化钠注射液，20 mg/d。两组均连续治疗1周。观察两组的近期疗效和远期疗效，对比两组美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）评分、血清中神经生长因子（NGF）、神经营养因子（NTF）、脑源性神经营养因子（BDNF）及视锥蛋白样蛋白-1（VILIP-1）、不良事件发生情况。结果 治疗后，治疗组总有效率是92.16%，显著高于对照组的74.51%（P＜0.05）。治疗1周、1个月两组患者NIHSS评分均较治疗前下降（P＜0.05），且治疗组治疗1周、1个月NIHSS评分均低于对照组（P＜0.05）。治疗组远期预后良好例数显著多于对照组，mRS评分低于对照组（P＜0.05）。治疗后，两组患者血清NTF、BDNF、NGF较治疗前显著升高，而VILIP-1水平降低（P＜0.05）；治疗后，治疗组血清NTF、BDNF、NGF高于对照组，而VILIP-1低于对照组（P＜0.05）。治疗后，治疗组和对照组不良事件发生率分别是3.92%、21.57%，两组差异显著（P＜0.05）。结论 针对超静脉溶栓时间窗的急性脑梗死患者，在标准化治疗基础上联合倍他司汀与替罗非班利于提高患者近期疗效，促进远期预后的良性转归与神经功能恢复，改善神经因子异常表达，降低不良事件发生率。

Objective To explore the efficacy of betahistine combined with tirofiban in treatment of acute cerebral infarction prolonged thrombolytic treatment time window. Methods From October 2024 to October 2025, 102 patients with cute cerebral infarction prolonged thrombolytic treatment time window admitted to Yantai Affiliated Hospital of Binzhou Medical University were selected and divided into control group and treatment group according to random number table method, with 51 cases in each group. Patients in control group were given Tirofiban Hydrochloride Injection, with a bolus dose of 0.4μg/(kg·min) for 3 min, total dose ≤ 1 mg, followed by continuous infusion at 0.1 μg/(kg·min) for 24 h. Patients in treatment group were given intravenous infusion of Betahistine Hydrochloride and Sodium Chloride Injectionm 20 mg/d on the basis of control group’s plan. Both groups were treated continuously for 1 week. The short-term and long-term therapeutic effects of two groups were observed, and the scores of the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS), the levels of neurotrophic factor (NGF), neurotrophic factor (NTF), brain-derived neurotrophic factor (BDNF), and cone protein-like protein-1 (VILIP-1) in serum, as well as the occurrence of adverse events in two groups were compared. Results After treatment, the short-term total effective rate of treatment group was 92.16%, significantly higher than that of control group (74.51%) (P< 0.05). The NIHSS scores of both groups decreased compared to those before treatment at 1 week and 1 month (P < 0.05), and the NIHSS scores of treatment group at 1 week and 1 month were lower than those of control group (P< 0.05). The number of patients with good long-term prognosis in treatment group was significantly higher than that in control group, and the mRS score was lower than that of control group (P < 0.05). After treatment, the serum levels of NTF, BDNF, and NGF in both groups significantly increased compared to those before treatment, but the level of VILIP-1 decreased (P< 0.05). After treatment, the serum levels of NTF, BDNF, and NGF in treatment group were higher than those in control group, but the level of VILIP-1 was lower than that in control group (P < 0.05). After treatment, the incidence of adverse events in treatment group and t control group was 3.92% and 21.57%, respectively, and the difference between two groups was significant (P < 0.05). Conclusion For patients with acute cerebral infarction prolonged thrombolytic treatment time window, combining betahistine and tirofiban with standard treatment is beneficial for improving the short-term efficacy of patients, promoting the favorable prognosis and neurological function recovery in long term, correcting the abnormal expression of neurofactors, and reducing the incidence of adverse events.

R971

山东省医药卫生科技发展计划项目（2022WS026）