目的 觀(guān)察曲克蘆丁腦蛋白水解物聯(lián)合阿替普酶治療急性腦梗死的臨床效果。方法 選擇2019月12—2021年12月南陽(yáng)市中心醫(yī)院接收的106例急性腦梗死患者，隨機(jī)分為對(duì)照組和治療組，每組各53例。對(duì)照組予以注射用阿替普酶0.9 mg/kg，在超聲引導(dǎo)下給藥，先靜推10%，60 s內(nèi)結(jié)束，剩余靜脈滴注，60 min內(nèi)結(jié)束，依照超聲監(jiān)測(cè)結(jié)果可適當(dāng)調(diào)整劑量，治療1次，溶栓后繼續(xù)予以常規(guī)治療至2周。治療組在對(duì)照組基礎(chǔ)上靜脈滴注曲克蘆丁腦蛋白水解物注射液，10 mL融于250 mL生理鹽水混勻，1次/d，持續(xù)應(yīng)用2周。觀(guān)察兩組患者臨床療效，比較治療前后兩組患者美國(guó)國(guó)立衛(wèi)生研究院腦卒中量表（NIHSS）和改良Rankin量表（MRS）評(píng)分，腦血流動(dòng)力學(xué)指標(biāo)平均血流速度（V_m）、舒張末期血流速度（V_d）和收縮期峰值血流速度（V_p）水平，以及膜聯(lián)蛋白A2（Annexin A2）、同型半胱氨酸（Hcy）和血管內(nèi)皮生長(zhǎng)因子（VEGF）水平。結(jié)果 治療后，治療組臨床總有效率（90.57%）較對(duì)照組（75.47%）明顯升高（P＜0.05）；治療后，兩組NIHSS評(píng)分、MRS評(píng)分均較治療前顯著降低（P＜0.05），且治療組較對(duì)照組降低更明顯（P＜0.05）。治療后，兩組大腦中動(dòng)脈（MCA）的Vm、Vd、Vp均較治療前顯著升高（P＜0.05），且治療組較對(duì)照組升高更顯著（P＜0.05）。治療后，兩組患者Annexin A2、VEGF水平均較治療前明顯升高，而Hcy水平均較治療前明顯降低（P＜0.05），且治療組患者Hcy、Annexin A2、VEGF水平明顯好于對(duì)照組（P＜0.05）。結(jié)論 曲克蘆丁腦蛋白水解物聯(lián)合阿替普酶治療急性腦梗死可調(diào)節(jié)Annexin A2、Hcy、VEGF水平，改善腦血流動(dòng)力學(xué)，發(fā)揮良好神經(jīng)保護(hù)作用，改善療效及預(yù)后。

Objective To observe the effect of troxerutin and cerebroprotein hydrolysate combined with alteplase in treatment of acute cerebral infarction.Methods Patients (106 cases) with acute cerebral infarction in Nanyang Central Hospital from December 2019 to December 2021 were randomly divided into control and treatment group, and each group had 53 cases. Patients in the control group were administered with Alteplase for injection, 0.9 mg/kg, 10% of the drug was injected intravenously within 60 s under the guidance of ultrasound, and the rest was iv administered with within 60 min, according to the results of ultrasound monitoring, the dosage could be adjusted appropriately, once treatment, and routine treatment continued to 2 weeks after thrombolysis. Patients in the treatment group were iv administered with Troxerutin and Cerebroprotein Hydrolysate Injection on the basis of the control group, 10 mL added into 250 mL normal saline, once daily, they were treated for 2 weeks. After treatment, the clinical evaluation was evaluated, the scores of NIHSS and MRS, the levels of cerebral hemodynamic indexes V_m, V_d and V_p, the Hcy, Annexin A2 and VEGF levels in two groups before and after treatment were compared. Results After treatment, the total clinical effective rate of the treatment group (90.57%) was significantly higher than that of the control group (75.47%) (P < 0.05); After treatment, the NIHSS score and MRS score of the two groups were significantly lower than those before treatment (P < 0.05), and the treatment group was significantly lower than that of the control group (P < 0.05). After treatment, the Vm, Vd and Vp of MCA in two groups were significantly higher than those before treatment (P < 0.05), and the increase in the treatment group was more significant than that in the control group (P < 0.05). After treatment, the levels of annexin A2 and VEGF in two groups were significantly higher than those before treatment, while the levels of Hcy were significantly lower (P < 0.05), and the levels of Hcy, annexin A2 and VEGF in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Troxerutin and cerebroprotein hydrolysate combined with alteplase in treatment of acute cerebral infarction can improve the levels of Annexin A2, Hcy and VEGF, cerebral hemodynamics, play a good neuroprotective effect, and improve the curative effect and prognosis.

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