目的 探討馬來酸桂哌齊特聯(lián)合西洛他唑治療下肢動(dòng)脈硬化閉塞癥的臨床療效。方法 選取2018年1月—2019年6月在三門峽市中心醫(yī)院收治的176例下肢動(dòng)脈硬化閉塞癥患者，隨機(jī)分為對(duì)照組和治療組，每組各88例。對(duì)照組患者口服西洛他唑片，100 mg/次，2次/d。治療組患者在對(duì)照組治療基礎(chǔ)上靜脈滴注馬來酸桂哌齊特注射液，320 mg加入生理鹽水500 mL，1次/d。兩組患者均連續(xù)治療2周。觀察兩組的臨床療效，比較兩組治療前后小腿部位皮溫、足背動(dòng)脈超聲檢查指標(biāo)、血流動(dòng)力學(xué)指標(biāo)、炎癥因子和氧化應(yīng)激指標(biāo)的變化情況。結(jié)果 治療后，對(duì)照組總有效率78.41%，治療組總有效率93.18%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，對(duì)照組與治療組患者小腿部位皮溫較治療前均顯著提高，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療后治療組患者小腿部位皮溫提高更明顯，差異存在統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，對(duì)照組與治療組患者足背動(dòng)脈血管內(nèi)徑、血流量較治療前均顯著提高（P<0.05），但峰值速度顯著下降（P<0.05）；且治療組上述指標(biāo)改善更明顯（P<0.05）。治療后，兩組患者全血高切黏度、全血低切黏度、血漿黏度、細(xì)胞沉降率水平較治療前均有顯著降低（P<0.05）；且治療組患者血流動(dòng)力學(xué)指標(biāo)降低的更明顯（P<0.05）。治療后，兩組腫瘤壞死因子-α（TNF-α）、細(xì)胞間黏附分子-1（ICAM-1）、白細(xì)胞介素-8（IL-8）水平較治療前均有顯著降低（P<0.05）；且治療組患者血清炎癥因子水平降低更明顯（P<0.05）。治療后，兩組丙二醛（MDA）、過氧化脂質(zhì)（LPO）水平較治療前均顯著下降（P<0.05）；且治療組患者血清氧化應(yīng)激指標(biāo)水平下降更明顯（P<0.05）。結(jié)論 桂哌齊特聯(lián)合西洛他唑治療下肢動(dòng)脈硬化閉塞癥具有較好的臨床療效，可顯著促進(jìn)患者的恢復(fù)，促進(jìn)局部血液循環(huán)，減少炎癥因子和氧化應(yīng)激產(chǎn)物的生成，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the clinical effect of cinepazide maleate combined with cilostazol in treatment of lower extremity arteriosclerosis obliterans. Methods Patients (176 cases) with lower extremity arteriosclerosis obliterans in Sanmenxia Central Hospital from January 2018 to June 2019were randomly divided into control and treatment groups with 88 cases in each group. The control group po administered with Cilostazol Tablets, 100 mg/time, twice daily. The treatment group was iv administered with Cinepazide Maleate Injection on the basis on of the control group, 320 mg added 500 mL of normal saline, once daily. All patients were treated for 2 weeks. The clinical efficacy was observed, and the changes of skin temperature of the lower leg, ultrasonic examination indexes of the dorsal artery of the foot, hemodynamic indexes, inflammatory factors and oxidative stress indexes in two groups before and after the treatment were compared. Results After treatment, the total effective rates of the control group and the treatment group were 78.41% and 93.18%, respectively, the total effective rate of the two groups was statistically significant (P<0.05). The skin temperature in the lower leg of both the control group and the treatment group was significantly higher than that before treatment (P<0.05). After treatment, the skin temperature of the lower leg of the patients in the treatment group increased more obviously (P<0.05). After treatment, both the control group and the treatment group showed a significant increase in the vascular diameter and blood flow of the dorsalis pedis (P<0.05), but the peak speed decreased significantly (P<0.05). The improvement of the above indexes was more obvious in the treatment group (P<0.05). After treatment, the levels of whole blood high cutting viscosity, whole blood low cutting viscosity, plasma viscosity and cell sedimentation rate in the two groups were significantly lower than those before treatment (P<0.05). In addition, the hemodynamic index of patients in the treatment group was more significantly reduced (P<0.05).After treatment, TNF-α, ICAM-1 and IL-8 levels in both groups were significantly reduced compared with those before treatment (P<0.05). Moreover, the level of serum inflammatory factors in the treatment group was more significantly reduced (P<0.05). After treatment, the levels of MDA and LPO in the two groups decreased significantly compared with those before treatment (P<0.05). Moreover, the level of serum oxidative stress indexes in the treatment group decreased more significantly (P<0.05). Conclusion Cinepazide maleate combined with cilostazol has a good clinical effect in treatment of lower extremity arteriosclerosis obliterans, and can significantly promote the recovery, promote the local blood circulationand, and can reduce the generation of inflammatory factors and oxidative stress products, which has a certain clinical application value.

R977