目的 探讨蛭蛇通络胶囊与依达拉奉右莰醇联合应用于脑梗死患者的临床治疗效果，研究其对患者神经功能缺损修复及血清相关生物学指标的调控作用，为临床优化脑梗死治疗方案提供参考依据。方法 筛选纳入2022年1月—2024年12月山西省汾阳医院收治的130例急性脑梗死患者，根据治疗方案的不同分为对照组、治疗组，两组病例各65例。对照组使用依达拉奉右莰醇注射用浓溶液进行治疗，取15 mL该制剂与0.9%氯化钠溶液充分混合后静脉滴注，2次/d。治疗组使用蛭蛇通络胶囊，3次/d，4粒/次，依达拉奉右莰醇注射用浓溶液用法用量与对照组一致。两组患者均连续治疗2周。比较两组患者干预后的临床治疗效果，并分析其美国国立卫生研究院卒中量表（NIHSS）与蒙特利尔认知评估量表（MoCA）治疗前后的评分变化及组间差异，检测两组血液流变学变化、血清相关指标。结果 治疗后，治疗组患者总有效率是93.85%，显著高于对照组的81.54%，具有统计学差异（P＜0.05）。治疗后，两组NIHSS评分下降，MoCA评分上升（P＜0.05）；且治疗组NIHSS评分低于对照组，MoCA评分高于对照组，具有统计学差异（P＜0.05）。治疗后，两组血浆黏度（PV）、全血高切黏度（HBV）、全血低切黏度（LBV）水平均下降（P＜0.05）；且治疗组PV、HBV、LBV水平低于对照组，具有统计学差异（P＜0.05）。治疗后，两组血清血栓素B2（TXB2）、内皮细胞特异分子1（ESM-1）、内皮素（ET）水平下降（P＜0.05）；且治疗组血清TXB2、ESM-1、ET水平低于对照组，具有统计学差异（P＜0.05）。治疗后，两组氧化型低密度脂蛋白（Ox-LDL）、超敏C反应蛋白（hs-CRP）、脂蛋白磷脂酶A2（Lp-PLA2）水平下降，过氧化氢酶（CAT）水平上升（P＜0.05），且治疗组Ox-LDL、hs-CRP、Lp-PLA2水平低于对照组，CAT水平高于对照组，具有统计学差异（P＜0.05）。结论 采用蛭蛇通络胶囊联合依达拉奉右莰醇对急性脑梗死患者实施联合治疗，可有效减轻其神经功能缺损程度、显著促进认知功能恢复、血液流变学，有效改善患者内皮功能，减轻患者脑组织氧化应激损伤、炎症损伤。

Objective To investigate the clinical therapeutic effect of the combined application of Zhishe Tongluo Capsules and Edaravone-Dexborneol Concentrated Solution for injection in patients with cerebral infarction, clarify its regulatory effect on the repair of neurological deficits and serum-related biological indicators, and provide a reference for the clinical optimization of treatment regimens for cerebral infarction. Methods A total of 130 patients with acute cerebral infarction who were screened and enrolled in Fenyang Hospital of Shanxi Province from January 2022 to December 2024 were divided into control group and treatment group using according to different treatment regimens, there were 65 cases in each of two groups. The control group was treated with Edaravone-Dexborneol Concentrated Solution for injection, 15 mL of the preparation was mixed thoroughly with 0.9% sodium chloride solution for intravenous drip, twice daily. Patients in treatment group were given Zhishe Tongluo Capsules, 3 times a day, 4 capsules each time. The dosage and administration of Edaravone and Dexborneol Concentrated Solution for injection were the same as those of control group. Both groups of patients were treated continuously for 2 weeks. The therapeutic effects of two groups and NIHSS scores and MoCA scores were compared. The changes of hemorheological and serum-related indicators of two groups were detected. Results After treatment, the total effective rate of the treatment group was 93.85%, significantly higher than that of the control group (81.54%), with a statistically significant difference (P < 0.05). After treatment, the NIHSS scores of both groups decreased and the MoCA scores increased (P < 0.05). Moreover, the NIHSS score of treatment group was lower than that of control group, and MoCA score was higher than that of control group, with statistically significant differences (P < 0.05). After treatment, the levels of PV, HBV, and LBV in both groups decreased (P < 0.05). Moreover, the levels of PV, HBV, and LBV in treatment group were lower than those in control group, with statistically significant differences (P < 0.05). After treatment, the levels of TXB2, ESM-1, and ET in both groups decreased (P < 0.05). Moreover, the levels of serum TXB2, ESM-1, and ET in the treatment group were lower than those in control group, with statistically significant differences (P < 0.05). After treatment, the levels of Ox-LDL, hs-CRP, and Lp-PLA2 decreased in both groups, while the level of CAT increased (P < 0.05). Moreover, the levels of Ox-LDL, hs-CRP, and Lp-PLA2 in treatment group were lower than those in control group. The CAT level was higher than that of control group, with a statistically significant difference (P < 0.05). Conclusion Combined intervention with Zhishe Tongluo Capsules and edaravone dexborneol in patients with acute cerebral infarction can effectively alleviate the degree of neurological deficits, significantly promote the recovery of cognitive function, improve hemorheological indices, effectively optimize endothelial function, and reduce oxidative stress injury and inflammatory injury of brain tissue in patients.

R971

吕梁市重点研发项目（2022SHFZ13）