目的 探討苦碟子注射液聯(lián)合阿替普酶治療急性腦梗死臨床療效。方法 選取2020年7月—2022年7月鄭州市第三人民醫(yī)院收治的112例急性腦梗死患者，隨機(jī)分為對(duì)照組和治療組，每組各56例。對(duì)照組患者靜脈注射注射用阿替普酶，0.9 mg/kg，最大劑量不超過90 mg，在1 min內(nèi)靜脈推注總藥量的10%，剩下的90%在1 h內(nèi)靜脈泵入。在對(duì)照組基礎(chǔ)上，治療組靜脈滴注苦碟子注射液，40 mL/次加入生理鹽水300 mL，1次/d。兩組治療14 d。觀察兩組患者臨床療效，比較治療前后兩組患者癥狀改善時(shí)間、神經(jīng)功能受損程度（NIHSS）評(píng)分、氧化應(yīng)激水平，血清炎性因子白細(xì)胞介素-6（IL-6）、胱抑素C（CysC）、腫瘤壞死因子-α（TNF-α）和同型半胱氨酸（Hcy）水平，及不良反應(yīng)情況。結(jié)果 治療后，治療組患者臨床有效率為91.07%，明顯高于對(duì)照組（71.43%，P＜0.05）。治療后，治療組癥狀改善時(shí)間均早于對(duì)照組（P＜0.05）。治療后，兩組患者NIHSS評(píng)分指標(biāo)均明顯下降（P＜0.05），且治療組NIHSS評(píng)分指標(biāo)明顯低于對(duì)照組（P＜0.05）。治療后，兩組患者超氧化物歧化酶（SOD）和谷胱甘肽過氧化物酶（CSH-Px）指標(biāo)明顯升高，而丙二醛（MDA）指標(biāo)明顯降低（P＜0.05），且治療組氧化應(yīng)激水平明顯好于對(duì)照組（P＜0.05）。治療后，兩組患者血清炎性因子IL-6、Cys-C、TNF-α、Hcy水平明顯降低（P＜0.05），且治療組明顯均低于對(duì)照組（P＜0.05）。治療后，治療組不良反應(yīng)總發(fā)生率為5.36%，明顯低于對(duì)照組（10.71%，P＜0.05）。結(jié)論 阿替普酶聯(lián)合苦碟子注射液治療急性腦梗死療效確切，對(duì)腦神經(jīng)功能損傷程度及氧化應(yīng)激反應(yīng)改善明顯，并能降低機(jī)體炎性因子水平，且安全性良好。

Objective To investigate the clinical study of Kudiezi Injection combined with alteplase in treatment of acute ischemic stroke. Methods Patients (112 cases) with acute ischemic stroke in Zhengzhou Third People’s Hospital from July 2020 to July 2022 were randomly divided into control and treatment group, and each group had 56 cases. Patients in the control group was iv administered with Alteplase for injection, 0.9 mg/kg, the maximum dose was no more than 90 mg, 10% of the total dose was injected intravenously within 1 min, and the remaining 90% was pumped intravenously within 1 h. Patients in the treatment group were iv administered with Kudiezi Injection on the basis of the control group, 40 mL/time added into normal saline 300 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical evaluation was evaluated, and the improvement time of symptom, NIHSS scores, oxidative stress response level, the levels of serum inflammatory factor IL-6, Cys-C, TNF-α and Hcy, and adverse reaction in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 91.07%, which was significantly higher than that of the control group (71.43%, P < 0.05). After treatment, the improvement time of symptom in the treatment group was earlier than that in the control group (P < 0.05). After treatment, the NIHSS score index in two groups was significantly decreased, and which in the treatment group was significantly lower than that of the control group (P < 0.05). After treatment, the indexes of SOD and CSH-Px in two groups were significantly increased, while the index of MDA was significantly decreased (P < 0.05), and the level of oxidative stress in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the levels of serum inflammatory factors IL-6, Cys-C, TNF-α and Hcy in two groups were significantly decreased (P < 0.05), and which in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the total incidence of adverse reactions in the treatment group was 5.36%, which was significantly lower than that in the control group (10.71%, P < 0.05). Conclusion Ateplase combined with Kudiezi Injection is effective in the treatment of acute cerebral infarction, which can significantly improve the degree of brain nerve function injury and oxidative stress response, and can reduce the level of inflammatory factors, and the safety is good.

R971

河南省醫(yī)學(xué)科技攻關(guān)項(xiàng)目（182102310172）