目的 觀察依達拉奉聯(lián)合胞二磷膽堿治療急性缺血性腦梗死的臨床療效和安全性。方法 上海市同仁醫(yī)院2009年5月—2013年5月入院治療的急性腦梗死患者90例，隨機分為依達拉奉組、胞二磷膽堿組和聯(lián)合用藥組，每組30例。在常規(guī)治療基礎上，依達拉奉組單用依達拉奉30 mg/次，2次/d；胞二磷膽堿組單用胞磷膽堿，750 mg/d；聯(lián)合用藥組聯(lián)用兩藥。3組療程均為14 d。治療前及后14、90 d，測量患者血清超氧物歧化酶（SOD）、神經(jīng)元特異性烯醇化酶（NSE）、高敏感性C-反應蛋白（Hs-CRP）水平，評定神經(jīng)功能缺損、日常生活能力、運動功能，分析臨床療效，檢測藥物安全性。結果 3組治療前血清中SOD、NSE、Hs-CRP水平以及NIHSS、ADL及MAS分數(shù)無統(tǒng)計學差異（P＞0.05）；治療后14 d，聯(lián)合用藥組SOD高于依達拉奉組（P＞0.05）、胞二磷膽堿組（P＜0.05）組，NSE、Hs-CRP低于依達拉奉組、胞二磷膽堿組（P＞0.05）；治療后90 d，聯(lián)合用藥組SOD高于依達拉奉組、胞二磷膽堿組（P＜0.05），NSE、Hs-CRP低于依達拉奉組、胞二磷膽堿組（P＜0.05）。3組NIHSS分數(shù)在治療后14、90 d降低（P＜0.05），ADL及MAS分數(shù)升高（P＜0.05）；聯(lián)合用藥組NIHSS分數(shù)在治療后14、90 d明顯低于依達拉奉組、胞二磷膽堿組（P＜0.05），ADL及MAS分數(shù)明顯高于依達拉奉組、胞二磷膽堿組（P＜0.05）。聯(lián)合用藥組治療后14 d療效分布與依達拉奉組、胞二磷膽堿組比較具有統(tǒng)計學差異（P＜0.05）。聯(lián)合用藥組14、90 d后治療有效例數(shù)及總有效率均高于依達拉奉組、胞二磷膽堿組。暫未發(fā)現(xiàn)嚴重不良反應。結論 相較單用依達拉奉或胞磷膽堿，兩藥聯(lián)合運用更能有效減少自由基水平、保護神經(jīng)元，更好地改善病情及預后，更有利于神經(jīng)功能、日常生活能力、運動功能恢復。

Objective To study the clinical efficacy and safety of edaravone combined with citicoline in the treatment of acute ischemic cerebral infarction. Methods The patients (90 cases) diagnosed as acute cerebral infarction in Shanghai Tong Ren Hospital from May 2009 to May 2012 were randomly divided into edaravone group, citicoline group, and combination group, each had 30 cases. On the basis of conventional therapy, the patients in the edaravone group were given edaravone, in the citicoline group were given citicoline, while in the combination group were given edaravone combined with citicoline for 14 d. Before the treatment, 14 d, and 90 d after the administration, the clinical efficacy and the changes of superoxide dismutase (SOD), neuronspecific enolase (NSE), and high-sensitivity C-reactive protein (Hs-CRP) levels were observed, and NHISS, ADL, and MAS were tested. Results Before the treatment, SOD, NSE, and Hs-CRP levels as well as NHISS, ADL, and MAS tests scores in the three groups had no statistical difference (P > 0.05). The SOD level in the combination group was higher than that in the edaravone group (P > 0.05) and the citicoline group (P < 0.05), while NSE and Hs-CRP levels in the combination group was less than those in the edaravone group and citicoline group (P > 0.05) in 14 d after the treatment. The SOD level in the combination group was higher than that in the edaravone group and citicoline group (P < 0.05), while NSE and Hs-CRP levels in the combination group were less than those in the edaravone group and citicoline group (P < 0.05) in 90 d after the treatment. Compared with the scores before the treatment, NIHSS scores in the all three groups decreased (P < 0.05), while ADL and MAS scores increased (P < 0.05) in 14 and 90 d after the treatment. Also NIHSS scores in the combination group were significantly lower than those in the edaravone group and citicoline group (P < 0.05), and its ADL and MAS scores were significantly higher than those in the edaravone group and citicoline group (P < 0.05). On day 14, the distribution of efficacy in the combination group had statistically significant difference compared with that in the edaravone group and citicoline group (P <0.05). The effective cases and rate in the combination group were higher than the number in the edaravone group and citicoline group in 14 and 90 d after the treatment. No serious adverse reactions had been reported. Conclusion Compared the treatment with the application of edaravone or citicoline alone, the combined use of the two drugs is more effective to the removal of free radicals, neurons protecion, the recovery of nerve function, daily function, and motor function, thereby improving the condition and prognosis.