目的 探讨己酮可可碱缓释片联合氯吡格雷治疗急性脑梗死的临床疗效。方法 选择2024年1月～12月盐城市第一人民医院收治的急性脑梗死患者82例，按随机数字表法将患者平均分为对照组和治疗组，每组各41例。对照组口服硫酸氢氯吡格雷片，75 mg/次，1次/d。在对照组基础上，治疗组饭后口服己酮可可碱缓释片，0.4 g/次，2次/d。两组患者治疗7 d。观察两组患者临床疗效，比较治疗前后两组患者美国国立卫生研究院卒中量表（NIHSS）、改良躯干损伤量表（mTIS）、改良Barthel指数（MBI）和症状自评量表（SCL-90）评分，及平均血小板体积（MPV）、系统免疫炎症指数（SII）、全身炎症反应指数（SIRI）、D-二聚体（D-D）和超敏C-反应蛋白（hs-CRP）水平。结果 治疗后，治疗组患者总有效率为95.12%，明显高于对照组的80.49%（P＜0.05）。治疗3、7 d后，两组NIHSS评分均低于治疗前，而治疗组NIHSS评分明显低于对照组同期（P＜0.05）。治疗后，两组mTIS、MBI评分显著升高，而SCL-90评分明显减少（P＜0.05），且治疗组评分明显好于对照组（P＜0.05）。治疗后，两组MPV、SII、SIRI、D-D和hs-CRP水平比治疗前明显下降（P＜0.05），且治疗组这些指标水平明显低于对照组（P＜0.05）。结论 己酮可可碱缓释片联合氯吡格雷治疗急性脑梗死能有效调节机体血小板活化程度和凝血功能，抑制炎症损伤，对促进患者神经功能恢复及改善躯干控制能力、日常活动能力和心理状态具有积极作用。

Objective To investigate the clinical efficacy of Pentoxifylline Sustained-release Tablets combined with clopidogrel in treatment of acute cerebral infarction. Methods Patients (82 cases) with acute cerebral infarction in Yancheng No.1 People’s Hospital from January 2024 to December were divided into control and treatment group by random number table method, and each group had 41 cases. Patients in the control group were po administered with Clopidogrel Bisulfate Tablets, 75 mg/time, once daily. Patients in the treatment group were po administered with Pentoxifylline Sustained-release Tablets on the basis of the control group after meals, 0.4g/time, twice daily. Patients in two groups were treated for 7 d. After treatment, the clinical evaluations were evaluated, and the scores of NIHSS, mTIS, MBI and SCL-90, and the levels of MPV, SII, SIRI, D-D and hs-CRP in two groups before and after treatment were compared. Results After treatment, the total effective rate of patients in the treatment group was 95.12%, which was significantly higher than 80.49% in the control group (P < 0.05). After treatment for 3 and 7 days, NIHSS scores in two groups were lower than those before treatment, while NIHSS scores in the treatment were significantly lower than those in the control group (P < 0.05). After treatment, mTIS and MBI scores in two groups were significantly increased, while NIHSS and SCL-90 scores were significantly decreased (P < 0.05), and the scores in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the levels of MPV, SII, SIRI, D-D and hs-CRP in two groups were significantly lower than those before treatment (P < 0.05), and the levels of these indicators in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion The treatment of acute cerebral infarction with Pentoxifylline Sustained-release Tablets combined with clopidogrel can effectively regulate the degree of platelet activation and coagulation function, inhibit inflammatory injury, and play a positive role in promoting the recovery of neurological function and improving trunk control ability, daily activity ability and psychological state of patients.

R971

盐城市卫生健康委科研项目（YK2023057）