目的 探讨培元通脑胶囊联合氯吡格雷治疗急性脑梗死的临床疗效。方法 纳入2021年1月—2024年6月首都医科大学附属北京友谊医院收治的84例老年急性脑梗死患者，按照随机数字表法为对照组和治疗组，每组各42例。对照组口服硫酸氢氯吡格雷片，75 mg/次，1次/d。治疗组在对照组治疗基础上联合口服培元通脑胶囊，3粒/次，3次/d。两组患者的疗程是14 d。观察两组临床疗效，比较治疗前后简明精神状况测验（MMSE）评分、美国国立卫生研究院卒中量表（NIHSS）评分、症状自评量表（SCL-90）评分、血小板指标、国际标准化比值（INR）、抗凝血酶Ⅲ（AT-Ⅲ）、纤维蛋白（原）降解产物（FDP）、D-二聚体（D-Dimer）、患侧大脑中动脉平均流速（V_m）、阻力指数（RI）、搏动指数（PI）及血沉（ESR）、全身免疫炎症指数（SII）、C反应蛋白（CRP）水平。结果 治疗后，治疗组总有效率（92.86%）显著高于对照组（76.19%，P＜0.05）。治疗后，两组MMSE评分都高于同组治疗前，NIHSS和SCL-90评分都低于同组治疗前（P＜0.05）；治疗组MMSE评分高于对照组，NIHSS和SCL-90评分低于对照组（P＜0.05）。治疗后，两组PAgT（AA）、PAgT（ADP）、PAdT（AA）、PAdT（ADP）都低于同组治疗前（P＜0.05）；治疗组PAgT（AA）、PAgT（ADP）、PAdT（AA）、PAdT（ADP）都低于对照组（P＜0.05）。治疗后，两组INR、AT-Ⅲ都高于同组治疗前，FDP、D-Dimer都低于同组治疗前（P＜0.05）；治疗组INR、AT-Ⅲ高对照组，FDP、D-Dimer低于对照组（P＜0.05）。治疗后，两组患侧大脑中动脉V_m都增加，RI与PI都降低（P＜0.05）；治疗组患侧大脑中动脉V_m高于对照组，RI与PI都低于对照组（P＜0.05）。治疗后，两组ESR、SII和CRP都低于同组治疗前（P＜0.05）；治疗后治疗组ESR、SII和CRP都低于对照组（P＜0.05）。结论 在急性脑梗死的治疗中联合培元通脑胶囊与氯吡格雷能通过抑制血小板活化、调节凝血–纤溶平衡、改善脑血流灌注及减轻全身炎症反应等作用，共同促进患者神经功能恢复、认知功能恢复，利于患者心理状态好转。

Objective To explore clinical efficacy of Peiyuan Tongnao Capsules combined with clopidogrel in treatment of acute cerebral infarction. Methods A total of 84 elderly patients with acute cerebral infarction who were admitted to Beijing Friendship Hospital, Capital Medical University from January 2021 to June 2024 were included. They were divided into control group and treatment group according to random number table method, with 42 cases in each group. Patients in control group were given oral administration of Clopidogrel Bisulfate Tablets at a dose of 75 mg each time, once daily. Patients in treatment group were treated in addition with Peiyuan Tongnao Capsules, 3 capsules each time, 3 times daily. The treatment duration for both groups was 14 d. The clinical efficacy of two groups was observed, and comparisons were made between the pre-treatment and post-treatment scores of the Mini-Mental State Examination (MMSE), the National Institutes of Health Stroke Scale (NIHSS), the Symptom Checklist 90 (SCL-90), platelet indicators, international normalized ratio (INR), antithrombin III (AT-III), fibrin (ogen) degradation product (FDP), D-dimer (D-Dimer), the average flow velocity of the middle cerebral artery on the affected side (V_m), resistance index (RI), pulsatility index (PI), and erythrocyte sedimentation rate (ESR), systemic immune inflammatory index (SII), and C-reactive protein (CRP) levels. Results After treatment, the total effective rate of treatment group (92.86%) was significantly higher than that of control group (76.19%, P< 0.05). After treatment, the MMSE scores of both groups were higher than those before treatment in same group, and the NIHSS and SCL-90 scores were lower than those before treatment in same group (P < 0.05). After treatment, MMSE score of treatment group was higher than that of control group, and the NIHSS and SCL-90 scores were lower than those of control group (P< 0.05). After treatment, the PAgT (AA), PAgT (ADP), PAdT (AA), and PAdT (ADP) of both groups were lower than those before treatment in same group (P< 0.05). After treatment, PAgT (AA), PAgT (ADP), PAdT (AA), and PAdT (ADP) of treatment group were lower than those of control group (P < 0.05). After treatment, INR and AT-Ⅲ of both groups were higher than those before treatment in same group, and the FDP and D-Dimer were lower than those before treatment in same group (P < 0.05). INR and AT-Ⅲ of treatment group were higher than those of control group, and the FDP and D-Dimer were lower than those of control group (P < 0.05). After treatment, the V_m of the middle cerebral artery on the affected side of both groups increased, and RI and PI decreased (P< 0.05). V_m of the middle cerebral artery on the affected side of the treatment group was higher than that of control group, and RI and PI were lower than those of control group (P < 0.05). After treatment, ESR, SII, and CRP of both groups were lower than those before treatment (P < 0.05). After treatment, ESR, SII, and CRP of treatment group were lower than those of control group (P < 0.05). Conclusion In treatment of acute cerebral infarction, the combination of Peiyuan Tongnao Capsules and clopidogrel can promote the recovery of patients’ neurological and cognitive functions by inhibiting platelet activation, and regulate coagulation fibrinolysis balance, improve cerebral blood flow perfusion, and reduce systemic inflammatory reactions, which is beneficial for the improvement of patients’ psychological status.

R971

国家自然科学基金青年科学基金项目（81801334）