目的 探討消栓腸溶膠囊聯合阿替普酶治療急性腦梗死的臨床療效。方法 選取2016年2月-2017年4月在漯河市中醫(yī)院治療的急性腦梗死患者94例，根據用藥的差別分為對照組（47例）和治療組（47例）。對照組靜脈推入注射用阿替普酶，先以總劑量的10%按0.9 mg/kg（最大劑量為90 mg）的量推入，剩余劑量加入100 mL生理鹽水，60 min持續(xù)靜脈滴注，1次/d。治療組在對照組基礎上口服消栓腸溶膠囊，0.4 g/次，3次/d。兩組患者均連續(xù)治療2周。觀察兩組患者臨床療效，比較治療前后兩組患者NIHSS、FMI和MBI評分及血清學指標和血液流變學指標。結果 治療后，對照組臨床有效率為82.98%，顯著低于治療組的97.87%，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療后，兩組NIHSS評分顯著降低，FMI和MBI評分顯著增加，同組比較差異具有統(tǒng)計學意義（P<0.05）；且治療后治療組上述評分明顯優(yōu)于對照組（P<0.05）。治療后，兩組患者血清脂蛋白磷脂酶A2（Lp-PLA2）、血小板活化因子（PAF）、淀粉樣蛋白（SAA）水平顯著降低，神經生長因子（NGF）和胰島素樣生長因子-1（IGF-1）水平顯著增加，同組比較差異具有統(tǒng)計學意義（P<0.05）；且治療組上述血清學指標水平明顯優(yōu)于對照組（P<0.05）。治療后，兩組患者全血黏度（WBV）、血漿黏度（PV）、纖維蛋白原（FIB）和血小板黏附率（PAR）均顯著降低（P<0.05）；且治療組血液流變學指標顯著低于對照組（P<0.05）。結論 消栓腸溶膠囊聯合阿替普酶治療急性腦梗死可有效降低機體炎癥水平，促進神經細胞因子分泌，改善機體血液流變學指標。

Objective To evaluate the clinical efficacy of Xiaoshuan Enteric-coated Capsules combined with alteplase in treatment of acute cerebral infarction. Methods Patients (94 cases) with acute cerebral infarction in Luohe Hospital of Chinese Medicine from February 2016 to April 2017 were divided into control (47 cases) and treatment (47 cases) based on different treatments. Patients in the control group were intravenous injection administered with Alteplase for injection, firstly, 0.9 mg/kg of 10% of the total dose and the maximum dose was 90 mg, the residual dose was added into normal saline 100 mL for 60 min. Patients in the treatment group were po administered with Xiaoshuan Enteric-coated Capsules on the basis of the control group, 0.4 g/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the NIHSS, FMI and MBI scores, the serological indexes and the hemorheological indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 82.98%, which was significantly lower than 97.87% in the treatment group, and there were differences between two groups (P < 0.05). After treatment, the NIHSS score in two groups was significantly decreased, but FMI and MBI scores were significantly increased, and the difference was statistically significant in the same group (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 Lp-PLA2, PAF and SAA levels in two groups were significantly decreased, but NGF and IGF-1 levels were significantly increased, and there were differences in the same group (P < 0.05), and the serological indexes in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the WBV, PV, FIB and PAR levels in two groups were significantly decreased (P < 0.05), and the hemorheological indexes in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Xiaoshuan Enteric-coated Capsules combined with alteplase in treatment of acute cerebral infarction can effectively reduce the level of inflammatory, promoting the secretion of nerve cytokines and improve the hemorheological indexes.