目的 探討通脈顆粒聯(lián)合丁苯酞治療急性腦梗死的臨床效果。方法 選取2016年3月-2019年3月朝陽市第二醫(yī)院收治的急性腦梗死患者120例，隨機(jī)分成對(duì)照組（60例）和治療組（60例）。對(duì)照組靜脈滴注丁苯酞氯化鈉注射液，25 mg/次，2次/d，緩慢滴注≥ 50 min，兩次給藥間隔≥ 6 h。治療組在對(duì)照組基礎(chǔ)上口服通脈顆粒，10 g/次，3次/d。兩組均連續(xù)治療2周。觀察兩組患者臨床療效，同時(shí)比較治療前后兩組患者美國國立衛(wèi)生研究院卒中量表（NIHSS）、改良Barthel指數(shù)（MBI）評(píng)分、血小板最大聚集率（MAR）值、血漿纖維蛋白原（FIB）和D-二聚體（D-D）水平，腦血流動(dòng)力學(xué)參數(shù)及血管內(nèi)皮生長因子（VEGF）、金屬基質(zhì)蛋白酶-9（MMP-9）、神經(jīng)元特異性烯醇化酶（NSE）和髓鞘堿性蛋白（MBP）水平。結(jié)果 治療后，對(duì)照組和治療組臨床有效率分別為80.00%和93.33%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者NIHSS評(píng)分均顯著低于治療前（P<0.05），而MBI評(píng)分均顯著升高（P<0.05），且治療組NIHSS、MBI評(píng)分的改善程度均顯著優(yōu)于對(duì)照組（P<0.05）。治療后，兩組患者M(jìn)AR值及血漿FIB、D-D水平均顯著降低（P<0.05），且治療組以上指標(biāo)的改善后水平明顯低于對(duì)照組（P<0.05）。治療后，兩組患者患側(cè)大腦中動(dòng)脈Vs、Vm值較治療前均顯著升高（P<0.05），而PI值則均顯著降低（P<0.05），且治療組患側(cè)大腦中動(dòng)脈血流動(dòng)力學(xué)參數(shù)值的改善效果較對(duì)照組同期更明顯（P<0.05）。治療后，兩組患者血清VEGF、MMP-9、NSE、MBP水平均較治療前顯著下降（P<0.05），且治療組上述血清學(xué)指標(biāo)水平降低更顯著（P<0.05）。結(jié)論 通脈顆粒聯(lián)合丁苯酞治療急性腦梗死的療效切實(shí)可靠，能明顯抑制患者體內(nèi)血栓形成，改善腦血流動(dòng)力學(xué)，促進(jìn)新生血管形成，減輕腦水腫，促進(jìn)神經(jīng)功能恢復(fù)，改善患者日常生活能力。

Objective To investigate the clinical effect of Tongmai Granules combined with butylphthalide in treatment of acute cerebral infarction. Methods Patients (120 cases) with acute cerebral infarction in Chaoyang Second Hospital from March 2016 to March 2019 were randomly divided into control (60 cases) and treatment (60 cases) groups. Patients in the control group were iv administered with Butylphthalide and Sodium Chloride Injection, 25 mg/time, twice daily, the drip time was not less than 50 min, and the interval time between two administration was not less than 6 h. Patients in the treatment group were po administered with Tongmai Granules on the basis of the control group, 10 g/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the NIHSS scores, MBI scores, MAR value, FIB and D-D content in plasma, hemodynamic parameters, and GF, MMP-9, NSE and MBP levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 80.00% and 93.33% respectively, and there were differences between two groups (P < 0.05). After treatment, the NIHSS scores in two groups were significantly decreased (P < 0.05), but the MBI scores were significantly increased (P < 0.05), and these scores in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the MAR value, FIB and D-D content in plasma in two groups were significantly decreased (P < 0.05), and these indicators in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the Vs and Vm value of cerebral artery in two groups was significantly increased (P < 0.05), but the PI value was significantly decreased (P < 0.05), and the hemodynamic parameters of cerebral artery in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the serum levels of VEGF, MMP-9, NSE and MBP in two groups were significantly decreased (P < 0.05), and these indexes in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Tongmai Granules combined with butylphthalide in treatment of acute cerebral infarction is effective and reliable, which can significantly inhibit thrombosis, improve cerebral hemodynamics, promote neovascularization, reduce cerebral edema, promote recovery of neurological function, and improve patients' daily living ability.

R971