目的 觀察注射用丹參多酚酸聯(lián)合肝素治療進(jìn)展性腦卒中的臨床療效及安全性。方法 選取2017年3月—2019年3月在河南大學(xué)第一附屬醫(yī)院老年神經(jīng)內(nèi)科就診的進(jìn)展性腦卒中患者106例為研究對(duì)象，隨機(jī)分為對(duì)照組和觀察組，每組各53例。對(duì)照組于48 h內(nèi)緩慢靜脈推注肝素鈉注射液，20～50 mg緩慢靜脈推注，然后50 mg加入到生理鹽水50 mL微量泵持續(xù)靜脈泵入8～12 h，連用3～5 d，期間根據(jù)活化部分凝血活酶時(shí)間（APTT）值調(diào)整肝素泵速，使APTT值穩(wěn)定在正常值的1.5～2.5倍，之后改為低分子量肝素鈣注射液，4100 U皮下注射，2次/d，療程7 d。觀察組在對(duì)照組基礎(chǔ)上靜脈滴注注射用丹參多酚酸，0.13 g加入250 mL生理鹽水，控制滴速不高于40滴/min，1次/d，療程14 d。觀察兩組患者的臨床療效，同時(shí)比較兩組患者治療前后的美國(guó)國(guó)立衛(wèi)生研究院卒中量表（NIHSS）、Barthel指數(shù)（BI）評(píng)分、超敏C-反應(yīng)蛋白（hs-CRP）、氧化型低密度脂蛋白（ox-LDL）和內(nèi)皮素-1（ET-1）水平。結(jié)果 治療后，對(duì)照組有效率為58.49%；觀察組有效率為79.25%；觀察組有效率高于對(duì)照組，差異有顯著性（P<0.05）。治療后，兩組NIHSS評(píng)分較治療前均降低，BI評(píng)分較治療前均升高，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組治療后NIHSS評(píng)分和BI評(píng)分顯著優(yōu)于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組hs-CRP、ox-LDL和ET-1水平均下降，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組下降更明顯，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 注射用丹參多酚酸聯(lián)合肝素能通過(guò)抗炎抗氧化、保護(hù)血管等機(jī)制改善進(jìn)展性腦卒中患者的神經(jīng)功能障礙，改善預(yù)后，且臨床用藥安全性良好。

Objective To observe the clinical efficacy and safety of Salvianolic Acids for Injection combined with heparin in treatment of acute progressive stroke. Methods Patients (106 cases) with progressive stroke from March 2017 to March 2019 in the department of geriatric neurology, the First Affiliated Hospital of Henan University were selected and randomly allocated into control group and observation group, 53 cases of patients in each group. Patients in the control group were intravenously injected with Heparin Sodium Injection within 48 h, and 20 — 50 mg was slowly intravenously injected, then 50 mg added into saline 50 mL continuously pumped intravenously for 8 — 12 h by micro pump, and used for 3 — 5 d. During the treatment period, the heparin pump speed was adjusted according to the APTT value, so that the APTT value was stable at 1.5 — 2.5 times of the normal value. After that, it was changed to Low Molecular Weight Heparin Calcium Injection, 4100 U subcutaneous injection, twice daily, and the course of treatment was 7 d. Patients in the control group were iv administered with Salvianolic Acids for Injection on the basis of control group, 0.13 g added into normal saline 250 mL, the dripping rate not higher than 40 drops/min, once daily for 14 d. The clinical efficacy of the two groups was observed, and the levels of the NIHSS, BI score, hs-CRP, ox-LDL, and ET-1 before and after treatment were compared. Results After treatment, the effective rate of the control group was 58.49%, the effective rate of observation group was 79.25%, the effective rate of the observation group was higher than that of the control group, and the difference was significant (P < 0.05). After treatment, the NIHSS score of both groups was lower than that before treatment, and the BI score was higher than that before treatment, the difference between the two groups before and after treatment was statistically significant (P < 0.05). After treatment, NIHSS score and BI score in the observation group were significantly better than that in the control group, and the difference between the two groups was statistically significant (P < 0.05). After treatment, hs-CRP, ox-LDL and ET-1 levels in two groups were decreased, with statistically significant differences between the two groups before and after treatment (P < 0.05). The decrease was more significant in the observation group, and the difference between two groups was statistically significant (P < 0.05). Conclusion Salvianolic Acids for Injection combined with heparin can improve the neurological dysfunction and prognosis of patients with progressive stroke by anti-inflammatory, antioxidant, vascular protection, and other mechanisms, and the clinical drug safety is good.

R969.4

河南省教育廳科學(xué)技術(shù)研究重點(diǎn)項(xiàng)目（16B320008）；河南省教育廳高等學(xué)校重點(diǎn)科研項(xiàng)目（18B310013）