目的 探讨通心络胶囊联合替罗非班治疗老年急性脑梗死的临床疗效。方法 纳入2022年5月—2025年7月邢台市人民医院收治的112例老年急性脑梗死患者，按随机数字表法分为对照组和治疗组，每组各56例。对照组静脉输注盐酸替罗非班氯化钠注射液，起始滴注速率为0.4 μg/(kg·min)，持续30 min，之后以0.1 μg/(kg·min)的维持剂量持续滴注，连续治疗72 h，后继续常规治疗。在对照组基础上，治疗组口服通心络胶囊，4粒/次，3次/d。两组患者疗程14 d。比较两组临床疗效，治疗前后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，血小板参数，患侧大脑中动脉收缩期血流速度（V_s）、平均血流速度（V_m）、搏动指数（PI），以及系统性免疫炎症指数（SII）、淋巴细胞与单核细胞比值（LMR）、红细胞分布宽度与白蛋白比值（RAR）水平。结果 治疗后，治疗组总有效率为94.64%，较对照组的82.14%明显升高（P＜0.05）。治疗后，两组NIHSS、SCL-90评分均显著减少（P＜0.05），且治疗组评分明显低于对照组（P＜0.05）。治疗后，两组PDW、MPV、PagT水平均明显降低（P＜0.05），且治疗组血小板参数水平明显低于对照组（P＜0.05）。治疗后，两组患侧大脑中动脉V_s、V_m比治疗前明显增加，而PI明显降低（P＜0.05），且治疗组脑血流动力学参数水平明显优于对照组（P＜0.05）。治疗后，两组SII、RAR水平比治疗前显著降低，而LMR明显升高（P＜0.05），且治疗组患者这些指标水平明显优于对照组（P＜0.05）。结论 老年急性脑梗死采用通心络胶囊联合替罗非班治疗，能有效发挥抑制患者机体血栓形成、调节免疫炎症反应及改善脑血流动力学和营养状态的作用，进一步提高改善微循环及神经保护的效果，且利于患者心理状态好转。

Objective To explore the clinical efficacy of Tongxinluo Capsules combined with tirofiban in the treatment of elderly patients with acute cerebral infarction. Methods A total of 112 elderly patients with acute cerebral infarction admitted to Xingtai People’s Hospital from May 2022 to July 2025 were enrolled and divided into a control group and a treatment group by the random number table method, with 56 cases in each group. The control group received intravenous infusion of tirofiban hydrochloride sodium chloride injection at an initial infusion rate of 0.4 μg/(kg·min) for 30 minutes, followed by a maintenance infusion rate of 0.1 μg/(kg·min) for continuous 72 hours, and conventional treatment was subsequently continued. On the basis of the control regimen, the treatment group was additionally administered oral Tongxinluo Capsules at a dose of 4 capsules three times daily. The treatment course of both groups lasted 14 days. The clinical efficacy, national institutes of health stroke scale (NIHSS) score, symptom checklist-90 (SCL-90) score, platelet parameters, systolic flow velocity (V_s), mean flow velocity (V_m) and pulsatility index (PI) of the affected middle cerebral artery, as well as systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR) and red cell distribution width-to-albumin ratio (RAR) were compared before and after treatment. Results After treatment, the total effective rate of the treatment group was 94.64%, which was significantly higher than 82.14% of the control group (P < 0.05). The NIHSS and SCL-90 scores in both groups were markedly decreased after treatment, with lower scores in the treatment group (P < 0.05). Meanwhile, platelet indices including PDW, MPV and PagT were obviously reduced in both groups, and the improvement was more significant in the treatment group (P < 0.05). In terms of cerebral hemodynamics, V_s and V_m of the affected middle cerebral artery were elevated while PI was decreased in the two groups, and the treatment group presented superior hemodynamic indicators (P < 0.05). Moreover, SII and RAR levels were down-regulated and LMR was up-regulated after treatment in both groups, and these immune-inflammatory and nutritional parameters were remarkably better regulated in the treatment group (P < 0.05). Conclusion For elderly patients with acute cerebral infarction, the combined treatment of Tongxinluo Capsules and tirofiban can effectively inhibit thrombosis, regulate immune and inflammatory responses, improve cerebral hemodynamics and nutritional status, enhance microcirculation repair and neuroprotection, and relieve negative psychological conditions, which possesses satisfactory clinical application value.

R971