目的 考察尿激酶靜脈溶栓后序貫應(yīng)用注射用丹參多酚酸治療急性缺血性腦卒中的臨床療效和安全性。方法 回顧性選取2018年3月—2020年5月安陽市人民醫(yī)院收治的急性缺血性腦卒中患者202例為研究對象，根據(jù)治療方法分為對照組（n=99）和聯(lián)合組（n=103），對照組于患者發(fā)病6 h內(nèi)應(yīng)用注射用尿激酶靜脈溶栓治療，用藥劑量為2.0×10⁴ U/kg，總劑量不超過1.5×10⁶ U，配以0.9%氯化鈉注射液100 mL，30 min內(nèi)持續(xù)靜脈泵入完畢，后續(xù)僅給于基礎(chǔ)治療。聯(lián)合組在對照組治療基礎(chǔ)上，于靜脈溶栓24 h后序貫應(yīng)用注射用丹參多酚酸0.13 g配以0.9%氯化鈉注射液250 mL，靜脈滴注，1次/d，療程為14 d。兩組患者均在尿激酶溶栓24 h后查頭顱CT排除出血轉(zhuǎn)化，給予規(guī)范應(yīng)用抗血小板聚集、調(diào)脂、控制危險(xiǎn)因素等基礎(chǔ)性治療。評估治療后7、14、90 d兩組患者美國國立衛(wèi)生研究院卒中量表（NIHSS）評分及改良Rankin量表（mRS）評分，比較兩組90 d mRS評分以及治療14 d腦出血及癥狀性腦出血率，并采用多因素Logistic回歸分析影響預(yù)后的危險(xiǎn)因素。結(jié)果 兩組患者治療后7 d NIHSS評分無統(tǒng)計(jì)學(xué)差異（P>0.05）。聯(lián)合組治療后14、90 d的NIHSS評分均低于對照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。聯(lián)合組較對照組90 d預(yù)后良好率高，差異具有統(tǒng)計(jì)學(xué)差異（P<0.05）。兩組患者治療后14 d出血率、癥狀性出血率均無統(tǒng)計(jì)學(xué)差異（P>0.05）。多因素Logistic回歸分析顯示，溶栓前NHISS評分≤7分（OR=0.177，95% CI 0.084～0.370，P<0.05）、發(fā)病至溶栓時(shí)間≤270 min（OR=0.342，95% CI 0.149～0.785，P<0.05）、使用注射用丹參多酚酸（OR=0.288，95% CI 0.143～0.580，P<0.05）是預(yù)后良好的保護(hù)因素。結(jié)論 尿激酶溶栓后序貫應(yīng)用注射用丹參多酚酸治療急性缺血性腦卒中安全有效，可以改善患者早期臨床癥狀，并促進(jìn)遠(yuǎn)期神經(jīng)功能康復(fù)、改善遠(yuǎn)期預(yù)后。

Objective To investigate the clinical efficacy and safety of sequential application of Salvianolic Acids for Injection in treatment of acute ischemic stroke after intravenous thrombolysis with urokinase. Methods Total 202 patients with acute ischemic stroke treated in Anyang People's Hospital from March 2018 to may 2020 were retrospectively selected as the research objects. According to the treatment methods, they were divided into control group (n=99) and combined group (n=103). Patients in the control group were treated with intravenous thrombolysis with Urinary Kallidinogenase Injection within six hours of onset, with a drug dose of 20 000 units/kg and a total dose of no more than 1.5 million units, 100 mL of 0.9% sodium chloride injection was added, and the continuous intravenous pumping was completed within 30 minutes. The follow-up were only given to basic treatment. Based on the treatment of the control group, patients in the combined group were treated with Salvianolic Acids for Injection 0.13 g for injection combined with 0.9% sodium chloride injection 250 mL, intravenous drip, once a day, for 14 days. The patients in both groups were examined by head CT 24 hours after thrombolysis with urokinase to eliminate bleeding and transformation, and were given basic treatment such as standardized application of antiplatelet aggregation, lipid regulation and control of risk factors. The scores of National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were evaluated at 7, 14 and 90 days after treatment. The 90 day mRS scores and the rates of intracerebral hemorrhage and symptomatic intracerebral hemorrhage at 14 days after treatment were compared between two groups, and the risk factors affecting the prognosis were analyzed by multivariate logistic regression. Results There was no significant difference in NIHSS score between two groups seven days after treatment (P>0.05). The NIHSS scores of the combined group at 14 and 90 days after treatment were lower than those of the control group (P<0.05). The 90 day good prognosis rate of the combined group was higher than that of the control group (P<0.05). There was no significant difference in bleeding rate and symptomatic bleeding rate between the two groups 14 days after treatment (P>0.05). Multivariate Logistic regression analysis showed that NHISS score ≤ 7 before thrombolysis (OR=0.177, 95% CI 0.084-0.370, P<0.05), time from onset to thrombolysis ≤ 270 min (OR=0.342, 95% CI 0.149-0.785, P<0.05), and use of Salvianolic Acids for Injection (OR=0.288, 95% CI 0.143-0.580, P<0.05) were protective factors with good prognosis. Conclusion Sequential application of Salvianolic Acids for Injection after thrombolysis with urokinase is safe and effective in treatment of acute ischemic stroke. It can improve the early clinical symptoms, promote the long-term neurological rehabilitation and improve the long-term prognosis.

R971