目的 探討腦血栓片聯(lián)合阿替普酶治療急性腦梗死的臨床效果。方法 將西安高新醫(yī)院于2021年3月—2023年6月期間收治的98例急性腦梗死患者，應用隨機數(shù)字表法將98例急性腦梗死患者均分為對照組（49例）和治療組（49例）。對照組患者采用注射用阿替普酶，劑量為0.9 mg/kg，最大劑量不超過90 mg，在治療開始的前1 min先將10%的劑量以靜脈推注的方式注入體內，剩余劑量則持續(xù)滴注60 min，治療1次，溶栓完成后繼續(xù)給予基礎治療。治療組患者在對照組治療基礎上口服腦血栓片，6片/次，3次/d。兩組均連續(xù)治療14 d。觀察兩組的臨床療效，比較兩組治療前后改良日常生活能力指數(shù)（Barthel）評分、美國國立衛(wèi)生研究院卒中量表（NIHSS）評分、同型半胱氨酸（Hcy）、白細胞介素-17（IL-17）、C反應蛋白（CRP）及血液流變學指標。結果 治療后，治療組總有效率為95.92%，顯著高于對照組的81.63%（P＜0.05）。治療后，兩組改良Barthel評分均高于治療前，而NIHSS評分均低于治療前（P＜0.05）；治療后，治療組改良Barthel評分及NIHSS評分改善情況更加明顯（P＜0.05）。治療后，兩組血清Hcy、IL-17、CRP水平均低于同組治療前（P＜0.05）；治療后，治療組血清Hcy、IL-17、CRP水平改善情況更加明顯（P＜0.05）。治療后，兩組各種切變速率下的全血黏度、纖維蛋白原、血漿黏度水平均低于治療前（P＜0.05）；治療后，治療組各種切變速率下的全血黏度、纖維蛋白原、血漿黏度水平改善情況更加明顯（P＜0.05）。結論 腦血栓片聯(lián)合阿替普酶治療急性腦梗死具有較好的臨床效果，可改善患者的神經功能受損情況及血液高凝狀態(tài)，提高患者獨立生活能力，并能有效降低血清Hcy水平及機體的炎癥反應，且安全性較好。

Objective To explore the clinical efficacy of Naoxueshuan Tablets combined with ateplase in treatment of acute cerebral infarction. Methods 98 Patients with acute cerebral infarction admitted to Xi’an Gaoxin Hospital from March 2021 to June 2023 were divided into control group (49 cases) and treatment group (49 cases) by random number table method. Patients in the control group were given Alteplase for injection, the dosage was 0.9 mg/kg, with the maximum dosage not exceeding 90 mg, and 10% of the dosage was injected intravenously 1 min before the start of treatment, and the remaining dosage was injected continuously for 60 min, treated once, and basic treatment was continued after completion of thrombolysis. Patients in the treatment group were po administered with Naoxueshuan Tablets on the basis of the control group, 6 tablets/time, three times daily. Both groups were treated continuously for 14 d. The clinical effects of the two groups were observed, and the Barthel scores, NIHSS scores, homocysteine (Hcy), interleukin-17 (IL-17), C-reactive protein (CRP) and hemorheology were compared between two groups before and after treatment. Results After treatment, the total effective rate of treatment group was 95.92%, which was significantly higher than that of control group (81.63%, P < 0.05). After treatment, the modified Barthel score in both groups was higher than before treatment, but the NIHSS score was lower than before treatment (P < 0.05). After treatment, the modified Barthel score and NIHSS score were significantly improved in treatment group (P < 0.05). After treatment, the levels of serum Hcy, IL-17, and CRP in 2 groups were lower than before treatment (P < 0.05). After treatment, the levels of serum Hcy, IL-17, and CRP in treatment group were significantly improved (P < 0.05). After treatment, the levels of whole blood viscosity, fibrinogen, and plasma viscosity under various shear rates were lower than before treatment (P < 0.05). After treatment, the levels of whole blood viscosity, fibrinogen and plasma viscosity were significantly improved under various shear rates in treatment group (P < 0.05). Conclusion Naoxueshuan Tablets combined with alteplase has good clinical efficacy in treatment of acute cerebral infarction, and can improve the neurological impairment and blood hypercoagulability of patients, and can improve the independent living ability of patients, which can effectively reduce the serum Hcy level and the inflammatory response with good safety.

R971

陜西省科學技術研究發(fā)展計劃（2020JM3068）