目的 探讨依达拉奉联合阿替普酶静脉溶栓治疗老年缺血性脑血管病的临床疗效。方法 选取2019年1月—2021年1月朝阳市第二医院就诊并治疗的老年缺血性脑血管病患者90例为研究对象，按照治疗方法的不同将其分为对照组和观察组，每组均45例。对照组采用阿替普酶0.9 mg/kg静脉溶栓治疗，其中10%于1 min内进行静脉推注，剩余90%＋250 mL0.9%氯化钠注射液行静脉滴注，注意最大用药剂量不超过80 mg。观察组患者在对照组基础上静脉滴注依达拉奉注射液，30 mg＋100 mL 0.9%氯化钠注射液，2次/d。两组患者均治疗2周。观察两组患者的临床疗效，对比两组治疗前后的NIHSS评分、血清氧化应激指标、炎症因子指标及脑血流速度等。结果 治疗后，观察组的总有效率为95.56%，明显高于对照组的80.00%，两组比较差异具有统计学意义（P<0.05）。两组经过治疗后NIHSS评分均较治疗前明显降低（P<0.05），且观察组NIHSS评分明显低于对照组（P<0.05）。两组经过治疗后的超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）均较治疗前明显升高（P<0.05），且观察组SOD、GSH-Px均明显高于对照组，有统计学意义（P<0.05）。两组经过治疗后的丙二醛（MDA）较治疗前明显降低（P<0.05），且观察组MDA明显低于对照组，有统计学意义（P<0.05）。两组经过治疗后C反应蛋白（CRP）、白细胞介素-6（IL-6）、_γ-干扰素（IFN_-γ）水平均较治疗前明显降低（P<0.05），且观察组CRP、IL-6、IFN_-γ水平均明显低于对照组（P<0.05）。两组经过治疗后脑血流速度均较治疗前明显升高（P<0.05），且观察组脑血流速度均明显高于对照组（P<0.05）。结论 依达拉奉联合阿替普酶静脉溶栓治疗缺血性脑血管病的效果较好，可有效改善患者的NIHSS评分，抑制炎症因子水平，调节血清氧化应激指标与脑血流速度，值得临床应用。

Objective To investigate the clinical effect of edaravone combined with alteplase in treatment of senile ischemic cerebrovascular disease. Methods A total of 90 elderly patients with ischemic cerebrovascular disease treated in the Chaoyang Second Hospital from January 2019 to January 2021 were selected as the research subjects. According to the different treatment methods, they were divided into control group and observation group, with 45 cases in each group. Patients in the control group were intravenous thrombolytic therapy with alteplase at 0.9 mg/kg, in which 10% was injected intravenously within 1 min, and the remaining 90% + 250 mL 0.9% sodium chloride injection was injected intravenously, noting that the maximum dose was not more than 80 mg. Patients in the observation group were iv administered with Edaravone Injection on the basis of control group, 30 mg + 100 mL 0.9% sodium chloride injection, twice daily. Patients in both groups were treated for 2 weeks. Clinical efficacy of two groups was observed, and NIHSS score, serum oxidative stress index, inflammatory factors index, and cerebral blood flow velocity before and after treatment were compared between two groups. Results After treatment, the total effective rate of the observation group was 95.56%, significantly higher than 80.00% of the control group, and the difference between the two groups was statistically significant (P < 0.05). After treatment, NIHSS scores in two groups were significantly lower than those before treatment (P < 0.05), and the NIHSS scores in observation group were significantly lower than those in control group (P < 0.05). After treatment, the levels of SOD and GSH-Px in two groups were significantly higher than before treatment (P < 0.05), and SOD and GSH-Px in the observation group were significantly higher than those in the control group, with statistical significance (P < 0.05). The MDA of two groups was significantly lower than that before treatment (P < 0.05), and the MDA of the observation group was significantly lower than that of the control group, with statistical significance (P < 0.05). After treatment, the levels of CRP, IL-6, and IFN_-γ in two groups were significantly decreased compared with before treatment (P < 0.05), and the levels of CRP, IL-6 and IFN_-γ in observation group were significantly lower than those in control group (P < 0.05). After treatment, the cerebral blood flow velocity of both groups was significantly higher than that before treatment (P < 0.05), and the cerebral blood flow velocity of observation group was significantly higher than that of control group (P < 0.05). Conclusion Edaravone combined with alteplase has a good effect on intravenous thrombolysis of ischemic cerebrovascular disease, which can effectively improve patients' NIHSS score, inhibit the level of inflammatory factors, regulate serum oxidative stress indexes and cerebral blood flow velocity, and is worthy of clinical application.

R971

辽宁省自然科学基金资助项目（20180550283）