目的 探討丁苯酞氯化鈉注射液聯(lián)合注射用阿替普酶治療急性腦梗死的臨床效果。方法 選取2015年8月-2017年5月在武漢市武昌醫(yī)院進(jìn)行治療的急性腦梗死患者72例為研究對象，將患者隨機(jī)分為對照組和治療組，每組各36例。對照組在腦部血栓內(nèi)給予注射用阿替普酶，0.3 mg/kg，總量不超過20 mg。治療組在對照組的基礎(chǔ)上靜脈注射丁苯酞氯化鈉注射液，25 mg/次，2次/d。兩組均連續(xù)治療14 d。觀察兩組的臨床療效，比較兩組的美國國立衛(wèi)生研究院卒中量表（NIHSS）評分、Barthel指數(shù)量表（BI）評分、改良Rankin評分量表（mRS）評分和預(yù)后情況。結(jié)果 治療后，對照組和治療組的總有效率分別為77.80%、94.40%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療7、14 d后，兩組NIHSS評分明顯降低，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組NIHSS評分明顯低于同期對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后30 d，對照組和治療組BI評分優(yōu)良率分別44.4%、69.4%，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）；治療后90 d，對照組和治療組mRS評分良好率分別為50.0%、75.0%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后90 d，對照組和治療組再發(fā)腦梗死率分別為33.3%、8.3%，對照組和治療組再發(fā)腦出血率分別為25.0%、5.6%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 丁苯酞氯化鈉注射液聯(lián)合注射用阿替普酶治療急性腦梗死具有較好的臨床療效，能改善神經(jīng)功能，提高生活質(zhì)量，減少再出血率、再梗死率，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical efficacy of Butylphthalide and Sodium Chloride Injection combined with Alteplase for injection in treatment of acute ischemic stroke. Methods Patients (72 cases) with acute ischemic stroke in Wuhan Wuchang Hospital from August 2015 to May 2017 were randomly divided into control and treatment groups, and each group had 36 cases. Patients in the control group were given Alteplase for injection into the brain thrombus, 0.3 mg/kg, and total amount was not more than 20 mg. Patients in the treatment group were iv administered with Butylphthalide and Sodium Chloride Injection on the basis of the control group, 25 mg/time, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and NIHSS score, BI score, mRS score, and prognosis in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 77.80% and 94.40%, respectively, and there was difference between two groups (P<0.05). After treatment 7 and 14 d, the NIHSS scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the NIHSS score in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment for 30 d, the excellent rates of BI score in the control and treatment groups were 44.4% and 69.4%, respectively, and there was difference between two groups (P<0.05). After treatment for 90 d, the good rates of mRS score in the control and treatment groups were 50.0% and 75.0%, respectively, and there was difference between two groups (P<0.05). After treatment for 90 d, the recurrent cerebral infarction rates in the control and treatment groups were 33.3% and 8.3%, respectively, the recurrent cerebral hemorrhage rates in the control and treatment groups were 25.0% and 5.6%, respectively, and there was difference between two groups (P<0.05). Conclusion Butylphthalide and Sodium Chloride Injection combined with Alteplase for injection has clinical curative effect in treatment of acute ischemic stroke, can improve the nerve function, enhance the quality of life, reduce the recurrent cerebral hemorrhage rate and recurrent cerebral infarction rate, which has a certain clinical application value.

武漢市臨床醫(yī)學(xué)科研項目（WX15C17）