目的 探討麝香四黃顆粒聯(lián)合注射用阿替普酶治療痰熱腑實(shí)型急性缺血性腦梗死患者的療效。方法 選取2019年7月-2020年12月濰坊市中醫(yī)院急診收入的80例痰熱腑實(shí)型急性缺血性腦梗死患者，按照治療方法將患者分為對(duì)照組和觀察組，每組各40例。對(duì)照組予以注射用阿替普酶，其中所需總量的10%在1 min內(nèi)靜脈推注，剩余90%靜脈泵入60 min；觀察組在對(duì)照組的基礎(chǔ)上沖服麝香四黃顆粒，1劑/d，分早晚2次服，療程為14 d。觀察兩組患者的臨床療效和中醫(yī)療效，比較兩組的美國(guó)國(guó)立衛(wèi)生研究院腦梗死量表評(píng)分（NIHSS）、Barthel指數(shù)、低密度脂蛋白（LDL-C）水平及中醫(yī)臨床證候積分指標(biāo)。結(jié)果 治療后，觀察組總有效率為87.5%，顯著高于對(duì)照組的77.5%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，觀察組中醫(yī)癥候療效明顯優(yōu)于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組中醫(yī)癥候積分明顯降低（P<0.05）；治療后，觀察組中醫(yī)癥候積分顯著低于同期對(duì)照組（P<0.05）。治療后7、14 d，兩組NIHSS評(píng)分均顯著降低，Barthel指數(shù)顯著升高（P<0.05）；且觀察組患者NIHSS評(píng)分顯著低于同期對(duì)照組，Barthel指數(shù)顯著高于同期對(duì)照組（P<0.05）。治療后7、14 d，兩組LDL-C水平均顯著降低（P<0.05）；且觀察組LDL-C水平顯著低于同期對(duì)照組（P<0.05）。結(jié)論 麝香四黃顆粒聯(lián)合阿替普酶治療痰熱腑實(shí)型急性缺血性腦梗死具有較好的臨床療效，可顯著改善患者的預(yù)后，安全有效。

Objective To explore the clinical effect of Shexiang Sihuang Granules combined with alteplase in treatment of phlegm-heat abdominal solid type acute cerebral infarction. Methods Eighty patients with acute ischemic cerebral infarction of phlegm-heat abdominal and real type who were admitted to the emergency department of Weifang Hospital of Traditional Chinese Medicine from July 2019 to December 2020 were selected. According to the treatment methods, the patients were divided into control group and observation group, with 40 cases in each group. Patients in the control group were received Alteplase for injection, in which 10% of the total amount needed was injected intravenously within 1 min, and the remaining 90% was pumped intravenously for 60 min. Patients in the observation group were po administered with Shexiang Sihuang Granules, 1 dose/d, twice in the morning and evening, for a course of 14 days. The clinical efficacy of two groups was observed, and the NIHSS score, Barthel index, LDL-C levels and TCM clinical syndrome score were compared between two groups. Results After treatment, the total effective rate of the observation group was 87.5%, significantly higher than 77.5% of the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, the curative effect of TCM syndrome in the observation group was significantly better than that in the control group, and the difference was statistically significant (P<0.05). After treatment, the scores of TCM symptoms in two groups were significantly decreased (P<0.05). After treatment, the scores of TCM symptoms in the observation group were significantly lower than those in the control group (P<0.05). On day 7 and 14 after treatment, NIHSS score was significantly decreased, and Barthel index was significantly increased in two groups (P<0.05). The NIHSS score of observation group was significantly lower than that of control group, and Barthel index was significantly higher than that of control group (P<0.05). On day 7 and 14 after treatment, the LDL-C level in two groups was significantly decreased (P<0.05); the level of LDL-C in observation group was significantly lower than that in control group (P<0.05). Conclusion Shexiang Sihuang Granules combined with alteplase in treatment of acute ischemic cerebral infarction of phlegm-heat abdominal compact type has good clinical efficacy, which can significantly improve the prognosis of patients, and is safe and effective.

R971

濰坊市科技發(fā)展計(jì)劃項(xiàng)目（2019YX010）