王福平 赖小梅 胡意

*基金项目：赣州市指导性科技计划项目（GZ2023ZSF583）

【摘要】 目的：探讨阿替普酶（rt-PA）静脉溶栓联合丁苯酞用于急性脑梗死（acute cerebral infarction，ACI）患者治疗中的临床效果。方法：以2022年1月—2023年6月瑞金市人民医院收治的ACI患者82例为研究对象，按随机数字表法分为对照组（脑梗死常规治疗+rt-PA静脉溶栓）、观察组（在对照组基础上联合应用丁苯酞），每组41例。观察对比两组神经功能缺损程度、生活自理能力、临床疗效、血清指标、不良反应发生率及生活质量评分。结果：治疗后两组美国国立卫生研究院卒中量表（national institutes of health stroke scale，NIHSS）评分较治疗前均降低，日常生活活动能力量表（activities of daily living，ADL）、健康调查简易量表（SF-36）评分较治疗前均升高，且观察组均优于对照组，差异均有统计学意义（P<0.05）；观察组临床总有效率高于对照组，差异有统计学意义（P<0.05）；两组不良反应发生率对比，差异无统计学意义（P>0.05）；治疗后两组脑钠肽（brain natriuretic peptide，BNP）、同型半胱氨酸（homocysteine，Hcy）、C反应蛋白（C reactive protein，CRP）水平均较治疗前降低，且观察组均低于对照组，差异均有统计学意义（P<0.05）。结论：ACI患者应用rt-PA静脉溶栓联合丁苯酞治疗，临床效果确切，且安全性高，可促进神经功能恢复，改善预后。

【关键词】 rt-PA静脉溶栓 丁苯酞 急性脑梗死 神经功能 生活质量

Effect Analysis of rt-PA Intravenous Thrombolysis Combined with Butylphthalide in Patients with Acute Cerebral Infarction/WANG Fuping， LAI Xiaomei， HU Yi. //Medical Innovation of China， 2024， 21（14）： 111-115

[Abstract] Objective： To investigate the clinical effects of Alteplase （rt-PA） combined with Butylphthalide in the treatment of acute cerebral infarction （ACI）. Method： A total of 82 patients with ACI admitted to Ruijin People's Hospital from January 2022 to June 2023 were divided into two groups： control group （conventional treatment of cerebral infarction + rt-PA intravenous thrombolysis） and observation group （combined application of Butylphthalide on the basis of control group）， with 41 cases in each group. The degree of neurological impairment， self-care ability， clinical efficacy， serum indexes， incidence of adverse reactions and quality of life score of the two groups were observed and compared. Result： After treatment， the national institutes of health stroke scale （NIHSS） scores in both groups were lower than those before treatment， the scores of activities of daily living （ADL） and the MOS item short form health survey （SF-36） were all increased compared with those before treatment， the observation group were superior to the control group， the differences were statistically significant （P<0.05）. The total clinical effective rate of the observation group was higher than that of the control group， the difference was statistically significant （P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. After treatment， the levels of brain natriuretic peptide （BNP）， homocysteine （Hcy） and C reactive protein （CRP） in both groups were lower than those before treatment， and the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： rt-PA intravenous thrombolysis combined with Butylphthalide therapy in ACI patients has definite clinical effect and high safety， which can promote the recovery of nerve function and improve the prognosis.

[Key words] rt-PA intravenous thrombolysis Butylphthalide Acute cerebral infarction Neurological function Quality of life

First-author's address： Department of Neurology， Ruijin People's Hospital， Ruijin 342500， China

doi：10.3969/j.issn.1674-4985.2024.14.027

急性脑梗死（acute cerebral infarction，ACI）属于危重症心血管疾病中的常见类型，占脑血管疾病的绝大多数，约70%，表现出高致残、高病死等特征。脑动脉粥样硬化是其重要病理基础，主要因脑供血不足，脑血管狭窄或完全闭塞，造成脑组织缺氧缺血性损伤坏死，临床治疗主要原则为改善脑血液循环[1-2]。本研究结合瑞金市人民医院接收的82例ACI患者，分析阿替普酶（rt-PA）静脉溶栓联合丁苯酞治疗的临床效果和安全性，为ACI患者的治疗提供了新的思路和选择，现报道如下。

1 资料与方法

1.1 一般资料

选取2022年1月—2023年6月本院收治的82例ACI患者为研究对象，纳入标准：（1）符合《中国急性缺血性脑卒中诊治指南（2014）》中ACI的诊断标准；……