目的 探討杜蛭丸聯(lián)合尤瑞克林治療老年急性腦梗死的臨床療效。方法 以2019年2月-2020年2月在鄭州大學(xué)第五附屬醫(yī)院進行治療的94例急性腦梗死患者為研究對象，根據(jù)用藥的差別分為對照組（47例）和治療組（47例）。對照組給予注射用尤瑞克林，0.15 PNA單位/次，同100 mL生理鹽水配伍，1次/d，30 min內(nèi)靜脈滴注完畢；治療組在對照組基礎(chǔ)上口服杜蛭丸，5 g/次，2次/d。兩組均治療2周后進行效果比較。觀察兩組的臨床療效，比較兩組治療前后相關(guān)評分、血清學(xué)因子、血管內(nèi)皮功能指標的變化情況。結(jié)果 經(jīng)治療，對照組總有效率為80.85%，顯著低于治療組（97.87%，P<0.05）。治療后，兩組美國國立衛(wèi)生研究院卒中量表（NIHSS）評分顯著降低，但功能獨立性評定（FIM）評分、蒙特利爾認知（MoCA）評分、簡明精神狀態(tài)量表（MMSE）評分均顯著提高（P<0.05），且治療后，治療組患者NIHSS評分顯著低于對照組，而FIM評分、MoCA評分、MMSE評分高于對照組（P<0.05）。治療后，兩組血清同型半胱氨酸（Hcy）、可溶性血管細胞黏附分子（sVCAM-1）、半乳糖凝集素3（Gal-3）、趨化因子CXCL12（CXCL12）、神經(jīng)元特異性烯醇化酶（NSE）、膠質(zhì)纖維酸性蛋白（GFAP）水平均顯著降低（P<0.05）；治療后，治療組血清學(xué)指標顯著低于對照組（P<0.05）。治療后，兩組血清血管性血友病因子（vWF）、內(nèi)皮素-1（ET-1）顯著降低，但內(nèi)皮細胞一氧化氮合酶（eNOS）水平均顯著升高（P<0.05）；治療后，治療組血清vWF、ET-1水平低于對照組，而eNOS水平高于對照組（P<0.05）。結(jié)論 杜蛭丸聯(lián)合尤瑞克林治療老年急性腦梗死效果良好，可促進患者神經(jīng)功能恢復(fù)，提高患者認知能力和生活質(zhì)量，可有效改善機體血清因子水平，具有一定的臨床推廣應(yīng)用價值。

Objective To explore the clinical effect of Duzhi Pills combined with urinary kallidinogenase in treatment of senium acute cerebral infarction. Methods A total of 94 patients with acute cerebral infarction treated in the Fifth Affiliated Hospital of Zhengzhou University from February 2019 to February 2020 were studied. According to the difference of drug usage, patients were divided into control group (47 cases) and treatment group (47 cases). Patients in the control group were given Urinary Kallidinogenase for injection, 0.15 PNA unit/time, compatible with 100 mL normal saline, once daily, and intravenous infusion was completed within 30 min. Patients in the treatment group were po administered with Duzhi Pills on the basis of the control group, 5 g/time, twice daily. The two groups were compared after 2 weeks of treatment. The clinical efficacy of the two groups was observed, and the changes of relevant scores, serological factors and vascular endothelial function indexes before and after treatment were compared between the two groups. Results After treatment, the total effective rate of the control group was 80.85%, significantly lower than that of the treatment group (97.87%, P<0.05). After treatment, NIHSS scores of the two groups were significantly reduced, but the FIM scores,Montreal Cognition (MoCA) scores and MMSE scores of the two groups were significantly increased (P<0.05). Moreover, the NIHSS score of the treatment group was significantly lower than that of the control group, while the FIM scores, MoCA scores and MMSE scores of the treatment group were significantly higher than those of the control group (P<0.05). After treatment, the serum levels of Hcy, SVCAM-1, Gal-3, CXCL12, NSE, and GFAP in the two groups were significantly decreased (P<0.05). After treatment, the serological indexes of the treatment group were significantly lower than those of the control group (P<0.05). After treatment, vWF and ET-1 were significantly decreased in both groups, but the levels of eNOS in endothelial cells were significantly increased in both groups (P<0.05). After treatment, the serum levels of vWF and ET-1 in the treatment group were lower than those in the control group, and the levels of eNOS were higher than those in the control group (P<0.05). Conclusion Duzhi Pills combined with urinary kallidinogenase has good therapeutic effect in treatment of senium acute cerebral infarction, and can promote patients' neurological function recovery, improve patients' cognitive ability and life quality, and effectively improve the serum factors, which has certain clinical popularization and application value.

R971

河南省醫(yī)學(xué)科技攻關(guān)計劃聯(lián)合共建項目（LHGJ20190412）