【目的】探讨银杏酮酯滴丸对脑梗死溶栓治疗后缺血再灌注损伤的保护作用及其对血小板功能的影响。 【方法】将120例 拟接受溶栓治疗的急性脑梗死患者随机分为观察组和对照组，每组各60例。2组患者均给予重组组织型纤溶酶原激活剂 （rt-PA） 进行溶栓治疗，观察组同时给予银杏酮酯滴丸治疗，对照组不予银杏酮酯滴丸治疗，疗程为14 d。观察2组患者入 院时 （治疗前） 和治疗后第14天的神经功能缺损程度美国国立卫生研究院卒中量表 （NIHSS） 评分、独立生活能力改良Rankin 量表 （mRS） 评分、血清神经元特异性烯醇化酶 （NSE） 、S100β蛋白 （S100β）、超敏C反应蛋白 （hs-CRP） 、D-二聚体、血小板 聚集率 （PAG） 、血小板活化度 （PAC-1） 等指标的变化情况。 【结果】（1） 主要观察指标方面，治疗后第14天，2组患者的 NIHSS评分和mRS评分均较入院时降低 （P＜0.01） ，且观察组对NIHSS评分和mRS评分的降低幅度均明显优于对照组，差异 均有统计学意义 （P＜0.01） 。 （2） 次要观察指标方面，治疗后第14天，2组患者的血清NSE、S100β、hs-CRP、D-二聚体、 PAG和PAC-1水平均较入院时降低 （P＜0.05或P＜0.01） ，且观察组对血清NSE、S100β、hs-CRP、D-二聚体、PAG和PAC-1 水平的降低幅度均明显优于对照组，差异均有统计学意义 （P＜0.01） 。 【结论】银杏酮酯滴丸对脑梗死溶栓治疗后缺血再灌注损 伤具有保护作用，可以减轻患者神经功能缺损，降低氧化应激和炎症反应，抑制血小板活化和聚集，减少出血转化风险。 关键词：银杏酮酯滴丸；脑梗死；缺血再灌注损伤；溶栓；血小板功能

Objective To investigate the protective effects of Yinxing Tongzhi Dripping Pills on ischemia- reperfusion injury after thrombolytic therapy for cerebral infarction and observe their effects on platelet function. Methods A total of 120 patients with acute cerebral infarction who were going to receive thrombolytic therapy in No. 989 Hospital of Joint Logistic Support Force of the Chinese People’ s Liberation Army were randomly divided into an observation group and a control group，60 cases in each group. Both groups were treated with recombinant tissue-type plasminogen activator （rt-PA） for thrombolytic therapy. Moreover，the observation group was treated with Yinxing Tongzhi Dripping Pills，while the control group was not medicated with Yinxing Tongzhi Dripping Pills. The course of treatment lasted for 14 days. At admission （before treatment） and 14 days after treatment，the two groups were observed in the changes of National Institutes of Health Stroke Scale （NIHSS） score for evaluating the neurological deficit ，modified Rankin Scale （mRS） score for evaluating the independent living ability，serum neuron-specific enolase （NSE） ，S100β protein （S100β），hypersensitive C-reactive protein （hs-CRP） ，D-dimer， platelet aggregation rate （PAG） and platelet activation degree （PAC-1） . Results （1） After 14 days of treatment， the primary outcomes of NIHSS score and mRS score of the two groups were lower than those at admission （P＜ 0.01） ，and the decrease of NIHSS score and mRS score in the observation group was significantly superior to that in the control group，the differences being statistically significant （P＜0.01） . （2） After 14 days of treatment，the secondary outcomes of the serum NSE，S100β，hs-CRP，D-dimer，PAG and PAC-1 levels in the two groups were lower than those at admission （P＜0.05 or P＜0.01），and the decrease of serum NSE，S100β，hs-CRP， D-dimer，PAG and PAC-1 levels in the observation group was significantly superior to that in the control group， the differences being statistically significant （P＜0.01） . Conclusion Yinxing Tongzhi Dripping Pills exert protective effects on ischemia-reperfusion injury after thrombolytic therapy for cerebral infarction. The pills are effective on relieving neurological deficits，reducing oxidative stress and inflammatory response，inhibiting platelet activation and aggregation，and lowering the risk of hemorrhagic transformation.

R277.7

国家自然科学基金资助项目 （编号：81974564）