目的 探究清開靈注射液聯(lián)合己酮可可堿治療急性腦梗死的臨床效果。方法 選取2023年1月—2024年3月在武漢市中醫(yī)醫(yī)院診治的急性腦梗死患者130例，隨機分成對照組和治療組，每組各65例。對照組患者靜脈滴注己酮可可堿注射液，1次/d，0.2 g溶解于100 mL生理鹽水，2 h內(nèi)輸注完畢。治療組患者在靜脈滴注己酮可可堿之外加用清開靈注射液靜脈輸注，每日2次，每次將20 mL藥液與100 mL生理鹽水混合后靜脈輸注。所有患者持續(xù)用藥14 d。對比兩組患者的臨床效果，統(tǒng)計分析治療前后中醫(yī)證候評分、NIHSS量表（美國國立衛(wèi)生研究院卒中量表）及mRS量表（改良Rankin量表）和擴散加權(quán)成像阿爾伯塔卒中項目早期CT評分（DWI-ASPECTS），血清脂蛋白磷脂酶A2（Lp-pLA2）、成纖維細(xì)胞生長因子4（FGF4）和神經(jīng)元PAS結(jié)構(gòu)域蛋白4（NPASDP4）水平。結(jié)果 治療后，治療組患者總有效率（95.38%）顯著高于對照組（83.08%），組間差異具有統(tǒng)計學(xué)意義（P＜0.05）。治療后，兩組中醫(yī)證候積分、NIHSS評分、mRS評分均顯著降低（P＜0.05），DWI-ASPECTS評分均明顯提升（P＜0.05）；治療組患者各評分改善幅度較對照組改善更明顯（P＜0.05）。治療后，治療組與對照組Lp-PLA2、FGF4及NPASDP4血清水平均顯著降低（P＜0.05），其中治療組各指標(biāo)降幅較對照組改善更顯著（P＜0.05）。隨訪分析結(jié)果顯示，對照組患者不良預(yù)后率為26.15%，顯著高于治療組的10.77%（P＜0.05）。結(jié)論 清開靈聯(lián)合己酮可可堿治療急性腦梗死療效顯著，不僅能夠顯著改善患者臨床癥狀、腦部缺血范圍及神經(jīng)缺損程度，還可通過改善腦微循環(huán)與抑制神經(jīng)炎癥協(xié)同作用提升治療效率。

Objective Exploring the therapeutic effect of Qingkailing Injection combined with pentoxifylline in treatment of acute cerebral infarction. Methods A total of 130 patients with acute cerebral infarction diagnosed and treated in Wuhan Hospital of Traditional Chinese Medicine from January 2023 to March 2024 were randomly divided into control group and treatment group, with 65 patients in each group. Patients in control group was given Pentoxifylline Injection, once daily, 0.2 g dissolved in 100 mL normal saline, and the infusion was completed within 2 h. Patients in treatment group were given intravenous infusion of Qingkailing Injection, in addition to intravenous infusion of pentoxifylline, twice daily, and each time 20 mL of liquid medicine was mixed with 100 mL of normal saline before intravenous infusion. All patients were treated for 14 d. After treatment, the clinical evaluations were evaluated, and the scores of TCM symptom, NIHSS, mRS, and DWI-ASPECTS, the levels of serum Lp-pLA₂, FGF4 and NPAS4, and prognosis within 3 months in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group (95.38%) was significantly higher than that of the control group (83.08%), and the difference was statistically significant (P < 0.05). After treatment, TCM syndrome scores, NIHSS scores and mRS Scores in both groups were significantly decreased (P < 0.05), while DWI-ASPECTS scores were significantly increased (P < 0.05). The improvement of all indexes in the treatment group was more obvious than that in the control group (P < 0.05). After treatment, the serum levels of Lp-PLA2, FGF4 and NPASDP4 in the treatment group and the control group were significantly decreased (P < 0.05), and the reduction of each index in the treatment group was more significant than that in the control group (P < 0.05). The results of follow-up analysis showed that the adverse prognosis rate of the control group was 26.15%, which was significantly higher than that of the treatment group (10.77%) (P < 0.05). Conclusion Qingkailing Injection combined with pentoxifylline is effective in the treatment of acute cerebral infarction, which can not only significantly improve the clinical symptoms, cerebral ischemia range and nerve defect degree of patients, but also improve the therapeutic efficiency by improving the synergistic effect of cerebral microcirculation and inhibiting neuroinflammation.

R971

老年腦健康中醫(yī)藥防護技術(shù)與新產(chǎn)品研發(fā)教育部工程研究中心開放基金（ZY2021M047）；武漢市中醫(yī)藥科研項目（WZ24M01）