目的 探讨急性脑梗死应用胞二磷胆碱联合尿激酶治疗的临床效果。方法 选取2016年1月—2018年6月襄阳市中心医院收治的102例急性脑梗死患者，运用随机数字表法随机分成对照组和治疗组，每组各51例。对照组静脉滴注注射用尿激酶，100万U注射用尿激酶溶于100 mL生理盐水，持续静脉滴注30 min，单次给药。治疗组在对照组治疗基础上静脉滴注胞二磷胆碱注射液，0.75 g加入150 mL生理盐水充分稀释，给药时间应大于40 min，1次/d。两组均治疗两周。观察两组的临床疗效，比较两组患者治疗前后血小板参数、国立卫生研究院卒中量表（NIHSS）评分、凝血–纤溶指标、脑血流动力学参数的变化情况。结果 治疗后，对照组和治疗组的总有效率分别为76.5%、92.2%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组血小板计数（PLC）显著增加，但血小板最大聚集率（PAGT_max）值和NIHSS评分均较治疗前显著减少，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组PLC值高于对照组，PAGT_max值和NIHSS评分低于治疗组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组纤维蛋白原（FIB）、D-二聚体（D-D）、外周阻力（R_v）水平均显著下降，两组平均血流速度（V_mean）和平均血流量（Q_mean）值较治疗前均显著增高，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组FIB、D-D、R_v水平显著低于对照组，V_mean和Q_mean显著高于对照组，两组比较差异具有统计学意义（P<0.05）。结论 胞二磷胆碱联合尿激酶治疗急性脑梗死具有较好的临床疗效，可有效抑制患者体内血小板活性，纠正凝血–纤溶系统紊乱，维持脑血流动力学稳定，减少神经功能缺损，具有一定的临床推广应用价值。

Objective to investigate the clinical effect of citicoline combined with urokinase in treatment of acute cerebral infarction. Methods 102 patients with acute cerebral infarction in Xiangyang Central Hospital from January 2016 to June 2018 were randomly divided into control (51 cases) and treatment (51 cases) groups. Patients in the control group were iv administered with Urokinase for injection, 1×10⁶ U was dissolved in normal saline100 mL, and continued intravenous infusion for 30 min with a single dosage. Patients in the treatment group were iv administered with Citicoline Injection on the basis of the control group, 0.75g was diluted with normal saline150 mL, and the dosage time should be more than 40 min, once daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the changes of platelet parameters, NIHSS score, coagulation-fibrinolysis indexes, and cerebral hemodynamic parameters in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 76.5% and 92.2%, and there were differences between two groups (P<0.05). After treatment, PLC in the two groups were significantly increased, but PAGTmax and NIHSS score were significantly decreased, and there were differences in the same group (P<0.05). After treatment, PLC in the treatment group was higher than those in the control group, but PAGTmax and NIHSS score were lower than those in the control group, and there were differences between two groups (P<0.05). After treatment, FIB, D-D, and Rv in the two groups were significantly decreased, but V_mean and Q_mean were significantly increased, and there were differences in the same group (P<0.05). After treatment, FIB, D-D, and Rv in the treatment group was lower than those in the control group, but V_mean and Q_mean were higher than those in the control group, and there were differences between two groups (P<0.05). Conclusion Citicoline combined with urokinase has significant clinical effect in treatment of acute cerebral infarction, and can effectively inhibit the platelet activity, and also can correct the disorder of coagulation-fibrinolysis system, maintain the stability of cerebral hemodynamics, and reduce the neurological defects, which has a certain clinical application value.