目的 分析丁苯酞序貫療法聯(lián)合阿替普酶溶栓對急性腦梗死患者的治療作用。方法 選擇2021年1月—2023年12月在上海市第一人民醫(yī)院嘉定醫(yī)院診治的急性腦梗死患者80例，以隨機抽簽法分為對照組和治療組，每組各40例。對照組靜脈滴注注射用阿替普酶，0.9 mg/kg，首先靜脈推注藥液總劑量的10%，60 s內推注完成，其余藥液需1 h內靜脈滴注完畢。在對照組基礎上，治療組靜脈滴注丁苯酞注射液2周，25 mg/次，2次/d，患者病情穩(wěn)定后口服丁苯酞軟膠囊，0.2 g/次，3次/d。兩組患者不間斷用藥3周。觀察兩組患者臨床療效，比較治療前后兩組患者血液流變學功能，凝血功能，神經功能缺損情況，認知功能、炎癥反應和神經影像學功能。結果 治療后，治療組患者總有效率明顯高于對照組（97.50% vs 80.00%，P＜0.05）。治療后，兩組患者血小板抑制率、凝血活酶時間（APTT）、凝血酶原時間（PT）、相對表觀擴散系數(shù)值（rADC）水平明顯升高，而血小板黏附率、全血黏度、紅細胞沉降率、血漿纖維蛋白原（FIB）、血小板（PLT）、白細胞計數(shù)、中性粒細胞比率、C反應蛋白（CRP）、梗死灶體積則明顯降低（P＜0.05），且治療后治療組這些指標明顯好于對照組（P＜0.05）。治療后，兩組患者NIHSS評分明顯低于治療前，而MMSE各評分明顯高于治療前（P＜0.05），且治療后治療組NIHSS和MMSE各評分明顯好于對照組（P＜0.05）。結論 丁苯酞序貫療法與阿替普酶溶栓相結合，可改善急性腦梗死患者的神經功能、血流動力學與凝血功能狀態(tài)，促使認知功能恢復，降低炎性反應。

Objective To analyze the effect of butylphthalide sequential therapy combined with alteplase in treatment of acute cerebral infarction. Methods Patients (80 cases) with acute cerebral infarction in Jiading Branch of Shanghai General Hospital from January 2021 to December 2023 were divided into control and treatment group by random draw, and each group had 40 cases. Patients in the control group were iv administered with Alteplase for injection, 0.9 mg/kg, first, 10% of the total dose was injected intravenously, and the bolus was completed within 60 s, and the rest medicine was injected intravenously within 1 h. Patients in the treatment group were iv administered with Butylphthalide Injection on the basis of the control group for 2 weeks, after the condition stabilized, they were po administered with Butylphthalide Soft Capsules, 0.2 g/time, three times daily. Patients in two groups were treated for 3 weeks. After treatment, the clinical evaluations were evaluated, the hemorheological function, coagulation function, neurological deficits, cognitive function, inflammatory response, neuroimaging function in two groups before and after treatment were compared. Results After treatment, the clinical effective rate in the treatment group was significantly higher than that in the control group (97.50% vs 80.00%, P < 0.05). After treatment, the platelet inhibition rate, APTT, PT, and rADC were significantly increased in two groups, while the platelet adhesion rate, whole blood viscosity, red blood cell sedimentation rate, FIB, PLT, white blood cell count, neutrophil ratio, CRP, and infarction volume were significantly decreased (P < 0.05), and the levels of these indicators in the treatment group were significantly better than those in the control group after treatment (P < 0.05). After treatment, the NIHSS scores in two groups were significantly lower than those before treatment, while the MMSE scores were significantly higher than those before treatment (P < 0.05). After treatment, the NIHSS and MMSE scores in the treatment group were significantly better than those of the control group (P < 0.05). Conclusions The combination of butylphthalide sequential therapy with alteplase thrombolysis can improve neurological function, hemodynamics and coagulation status in patients with acute cerebral infarction, promote the recovery of cognitive function, and reduce inflammatory response.

R971