目的 探討天丹通絡(luò)膠囊聯(lián)合注射用阿替普酶治療急性腦梗死的臨床療效。方法 選取2021年3月—2023年2月在如皋市人民醫(yī)院就診的100例急性腦梗死患者，按照隨機數(shù)字表法將所有患者分為對照組和治療組，每組各50例。對照組給予注射用阿替普酶，劑量0.9 mg/kg（不超過50 mg），先靜脈滴注劑量的10%，剩余的90%靜脈滴注60 min，治療1次，溶栓完成后繼續(xù)給予基礎(chǔ)治療。治療組在對照組基礎(chǔ)上口服天丹通絡(luò)膠囊，5粒/次，3次/d。兩組連續(xù)治療2周后統(tǒng)計療效。觀察兩組的臨床療效，比較兩組患者的美國國立衛(wèi)生研究院卒中量表（NIHSS）評分、超聲指標和血清指標。結(jié)果 治療后，治療組的總有效率94.00%明顯高于對照組的總有效率80.00%（P＜0.05）。治療后，兩組的NIHSS評分均顯著降低（P＜0.05），治療組NIHSS評分明顯低于對照組（P＜0.05）。治療后，兩組的腦血管儲備（CVR）、屏氣指數(shù)（BHI）顯著升高，病灶最長直徑顯著降低（P＜0.05）；治療組的CVR、BHI高于對照組，病灶最長直徑低于對照組（P＜0.05）。治療后，兩組的血清神經(jīng)元特異性烯醇化酶（NSE）、正五聚蛋白3（PTX3）、脂蛋白相關(guān)磷脂酶A2（Lp-PLA2）水平均低于治療前（P＜0.05）；治療后，治療組的血清NSE、PTX3、Lp-PLA2水平低于對照組，差異有統(tǒng)計學(xué)意義（P＜0.05）。結(jié)論 天丹通絡(luò)膠囊聯(lián)合注射用阿替普酶可提高急性腦梗死的臨床療效，能改善神經(jīng)功能，提高腦血流灌注，可能與減輕神經(jīng)細胞炎性損傷有關(guān)。

Objective To investigate the clinical effect of Tiandan Tongluo Capsules combined with Alteplase for injection in treatment of acute cerebral infarction. Methods Patients (100 cases) with acute cerebral infarction in the People’s Hospital of Rugao from March 2021 to February 2023 were divided into control and treatment groups according to the random number table method, and each group had 50 cases. Patients in the control group were given with Alteplase for injection, 0.9 mg/kg (not more than 50 mg). First, 10% of the dose was injected intravenously, and the remaining 90% was injected intravenously for 60 min, treated once, and basic treatment was continued after completion of thrombolysis. Patients in the treatment group were po administered with Tiandan Tongluo Capsules on the basis of the control group, 5 grains/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, and NIHSS scores, ultrasound indicators, and serum indicators in two groups were compared. Results After treatment, the total effective rate of 94.00% in the treatment group was significantly higher than that of 80.00% in the control group (P < 0.05). After treatment, NIHSS score of two groups was significantly decreased (P < 0.05), and the NIHSS score of the treatment group was significantly lower than that of the control group (P< 0.05). After treatment, CVR and BHI in two groups were significantly increased, but the longest lesion diameter in two groups was significantly decreased (P < 0.05). CVR and BHI in the treatment group were higher than those in the control group, but longest lesion diameter in the treatment group was lower than that in the control group (P < 0.05). After treatment, the serum levels of NSE, PTX3, and Lp-PLA2 in two groups were significantly decreased (P < 0.05). After treatment, the serum levels of NSE, PTX3, and Lp-PLA2 in the treatment group were lower than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion Tiantan Tongluo Capsules combined with Alteplase for injection can improve the therapeutic effect of acute cerebral infarction, improve nerve function and cerebral blood flow perfusion, which may be related to reducing inflammatory injury of nerve cells.

R971

如皋市科技攻關(guān)計劃項目[SRG(22)1072]