目的 探討天丹通絡(luò)膠囊聯(lián)合銀杏達(dá)莫和依達(dá)拉奉治療急性腦梗死的臨床療效。方法 選取2015年5月-2016年5月在安康市人民醫(yī)院接受治療的急性腦梗死患者88例，根據(jù)治療方案的差別分為對照組和治療組，每組各44例。對照組患者靜脈滴注銀杏達(dá)莫注射液，20 mL加入生理鹽水250 mL，2次/d；同時靜脈滴注依達(dá)拉奉注射液，30 mg加入生理鹽水100 mL，2次/d。治療組在對照組的基礎(chǔ)上口服天丹通絡(luò)膠囊，5粒/次，3次/d。兩組患者均連續(xù)治療2周。觀察兩組的臨床療效，記錄兩組治療前后神經(jīng)功能缺損（NIHSS）評分和Barthel指數(shù)的變化情況，同時比較兩組患者血漿黏度、全血黏度、血細(xì)胞比容（HCT）、紅細(xì)胞聚集指數(shù)（RF）、超敏C-反應(yīng)蛋白（hs-CRP）、腫瘤壞死因子-α（TNF-α）、基質(zhì)金屬蛋白酶-9（MMP-9）、血管內(nèi)皮生長因子（VEGF）、腦源性神經(jīng)營養(yǎng)因子（BDNF）、內(nèi)皮素-1（ET-1）和NO水平。結(jié)果 治療后，對照組和治療組的總有效率分別為81.82%和95.45%，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組患者NIHSS評分顯著降低，Barthel指數(shù)升高，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組NIHSS評分和Barthel指數(shù)的變化程度優(yōu)于對照組（P<0.05）。治療后，兩組患者血漿黏度、全血黏度、HCT和RF均較治療前顯著降低，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組血液流變學(xué)指標(biāo)的降低程度優(yōu)于對照組（P<0.05）。治療后，兩組患者h(yuǎn)s-CRP、TNF-α、MMP-9和ET-1水平均顯著降低，NO、BDNF和VEGF水平顯著升高，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組這些血清學(xué)指標(biāo)的改善程度優(yōu)于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 天丹通絡(luò)膠囊聯(lián)合銀杏達(dá)莫和依達(dá)拉奉治療急性腦梗死可明顯提高臨床療效，改善患者血液流變學(xué)狀態(tài)，并可降低血清炎性因子水平，具有一定的臨床推廣應(yīng)用價值。

Objective To study the clinical effect of Tiandan Tongluo Capsules combined with ginkgo leaf extract and dipyridamole and edaravone in treatment of acute cerebral infarction (ACI). Methods Patients (88 cases) with ACI in Ankang People's Hospital from May 2015 to May 2016 were enrolled in this study. According to the different treatment plans, patients were divided into control group and treatment group, and each group had 44 cases. The patients in the control group were iv administered with Ginkgo Leaf Extract and Dipyridamole Injection, 20 mL added into 250 mL normal saline, twice daily; And they were iv administered with Edaravone Injection, 30 mg added into 100 mL normal saline, twice daily. The patients in the treatment group were po administered with Tiandan Tongluo Capsules on the basis of the control group, 5 grains/time, three times daily. The patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, the changes of NIHSS scores and Barthel indexes were recorded before and after treatment in two groups, and plasma viscosity, whole blood viscosity, HCT, RF, and the expression levels of hs-CRP, TNF-α, MMP-9, VEGF, BDNF, ET-1, and NO in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 81.82% and 95.45%, respectively, and there were differences between two groups (P<0.05). After treatment, NIHSS scores in two groups were significantly decreased, Barthel indexes were increased, and the difference was statistically significant in the same group (P<0.05). And the changes of NIHSS scores and Barthel indexes in the treatment group were better than those in the control group (P<0.05). After treatment, plasma viscosity, whole blood viscosity, HCT, and RF in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the decrease degree of these blood rheology indexes in the treatment group was significantly better than those in the control group (P<0.05). After treatment, hs-CRP, TNF-α, MMP-9, and ET-1 levels in two groups were significantly decreased, the levels of NO, BDNF, and VEGF were increased, and the difference was statistically significant in the same group (P<0.05). And these serological indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Tiandan Tongluo Capsules combined with ginkgo leaf extract and dipyridamole and edaravone can improve the clinical efficacy in treatment of ACI, and can significantly improve blood rheology state and reduce the serum inflammatory factors levels, which has a certain clinical application value.