目的 探討丹燈通腦膠囊聯(lián)合丁苯酞治療急性腦梗死的臨床效果。方法 選取2018年8月-2020年7月南陽市中心醫(yī)院收治的86例急性腦梗死患者，按照治療方法將患者分成對照組（n=43）和觀察組（n=43）。對照組靜脈滴注丁苯酞氯化鈉注射液，25 mg/次，每次滴注時間≥ 50 min，2次/d（用藥時間間隔≥ 6 h）。觀察組在對照組基礎上口服丹燈通腦膠囊，1.4 g/次，3次/d。兩組均連續(xù)治療14 d。比較兩組臨床療效及安全性，觀察兩組治療前后腦卒中自我效能問卷（SSEQ）評分、美國國立衛(wèi)生研究院卒中量表（NIHSS）評分、大腦中動脈血流動力學參數(shù)[平均血流速度（Vm）、阻力指數(shù)（RI）]及血漿D-二聚體（D-D）、纖維蛋白原（FIB）水平和血清血管內(nèi)皮生長因子（VEGF）、血管性血友病因子（vWF）、多胺氧化酶（PAO）、金屬基質(zhì)蛋白酶（MMP）-9水平變化，并進行統(tǒng)計分析。結(jié)果 治療后，觀察組總有效率為93.0%，較對照組的76.7%顯著升高（P<0.05）。兩組治療后SSEQ評分均顯著增高，NIHSS評分則均顯著降低（P<0.05）；且治療后，觀察組SSEQ評分顯著高于對照組，NIHSS評分顯著低于對照組（P<0.05）。治療后，兩組大腦中動脈V_m較同組治療前均顯著增加，大腦中動脈RI及血漿FIB、D-D水平均較本組治療前顯著降低（P<0.05）；且與同期對照組比較，觀察組治療后大腦中動脈Vm顯著更高，大腦中動脈RI及血漿FIB、D-D水平均顯著更低（P<0.05）。兩組治療后血清VEGF、vWF、PAO及MMP-9水平均較本組治療前顯著下降（P<0.05）；且治療后，觀察組比對照組對血清VEGF、vWF、PAO和MMP-9水平的降低作用更顯著（P<0.05）。結(jié)論 丹燈通腦膠囊聯(lián)合丁苯酞治療急性腦梗死的整體療效顯著，能安全有效地改善患者腦血流動力學狀態(tài)，抑制血栓形成，減輕血管內(nèi)皮損傷，保護神經(jīng)功能，提高患者生活質(zhì)量，值得臨床推廣。

Objective To investigate the clinical effect of Dandeng Tongnao Capsules combined with butylphthalide in treatment of acute cerebral infarction. Methods A total of 86 patients with acute cerebral infarction admitted to Nanyang Central Hospital from August 2018 to July 2020 were selected, and the patients were divided into control group (n=43) and observation group (n=43) according to treatment methods. Patients in the control group were iv administered with Butylphthalide and Sodium Chloride Injection, 25 mg/time, each infusion time ≥ 50 min, twice daily (medication time interval ≥ 6 h). Patients in the observation group were po administered with Dandeng Tongnao Capsule on the basis of control group, 1.4 g/time, three times daily. Both groups were treated continuously for 14 d. Clinical efficacy and safety of two groups were compared. Observe of SSEQ scores, NIHSS score, arterial blood flow in the brain mechanics parameters (V_m, RI) and plasma D-D, FIB levels, and serum VEGF, vWF, PAO, and MMP-9 before and after the treatment between two groups were analyzed statistically. Results After treatment, the total effective rate of the observation group was 93.0%, which was significantly higher than 76.7% of the control group (P<0.05). After treatment, SSEQ score in two groups was significantly increased, while NIHSS score was significantly decreased (P<0.05). After treatment, the SSEQ score in the observation group was significantly higher than that in the control group, and the NIHSS score was significantly lower than that in the control group (P<0.05). After treatment, V_m of middle cerebral artery in two groups was significantly increased compared with before treatment, but RI of middle cerebral artery, plasma FIB and D-D levels were significantly decreased compared with before treatment (P<0.05). Moreover, compared with the control group at the same period, V_m of middle cerebral artery in the observation group was significantly higher after treatment, RI of middle cerebral artery, plasma FIB and D-D levels were significantly lower (P<0.05). After treatment, the levels of serum VEGF, vWF, PAO, and MMP-9 in two groups were significantly decreased compared with before treatment (P<0.05). After treatment, the observation group had more significant effect on the decrease of serum VEGF, vWF, PAO and MMP-9 levels than the control group (P<0.05). Conclusion Dandeng Tongnao Capsules combined with butylphthalide in treatment of acute cerebral infarction is significant, which can safely and effectively improve the state of cerebral hemodynamics, inhibit thrombosis, reduce vascular endothelial injury, protect neurological function, and improve the quality of life of patients, which is worthy of clinical promotion.

R971

南陽市衛(wèi)生和計劃生育委員會科研項目（ZD201778）