目的 观察注射用丹参多酚酸联合肝素治疗进展性脑卒中的临床疗效及安全性。方法 选取2017年3月—2019年3月在河南大学第一附属医院老年神经内科就诊的进展性脑卒中患者106例为研究对象，随机分为对照组和观察组，每组各53例。对照组于48 h内缓慢静脉推注肝素钠注射液，20～50 mg缓慢静脉推注，然后50 mg加入到生理盐水50 mL微量泵持续静脉泵入8～12 h，连用3～5 d，期间根据活化部分凝血活酶时间（APTT）值调整肝素泵速，使APTT值稳定在正常值的1.5～2.5倍，之后改为低分子量肝素钙注射液，4100 U皮下注射，2次/d，疗程7 d。观察组在对照组基础上静脉滴注注射用丹参多酚酸，0.13 g加入250 mL生理盐水，控制滴速不高于40滴/min，1次/d，疗程14 d。观察两组患者的临床疗效，同时比较两组患者治疗前后的美国国立卫生研究院卒中量表（NIHSS）、Barthel指数（BI）评分、超敏C-反应蛋白（hs-CRP）、氧化型低密度脂蛋白（ox-LDL）和内皮素-1（ET-1）水平。结果 治疗后，对照组有效率为58.49%；观察组有效率为79.25%；观察组有效率高于对照组，差异有显著性（P<0.05）。治疗后，两组NIHSS评分较治疗前均降低，BI评分较治疗前均升高，同组治疗前后比较差异具有统计学意义（P<0.05）；且观察组治疗后NIHSS评分和BI评分显著优于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，两组hs-CRP、ox-LDL和ET-1水平均下降，同组治疗前后比较差异具有统计学意义（P<0.05）；且观察组下降更明显，两组比较差异具有统计学意义（P<0.05）。结论 注射用丹参多酚酸联合肝素能通过抗炎抗氧化、保护血管等机制改善进展性脑卒中患者的神经功能障碍，改善预后，且临床用药安全性良好。

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

河南省教育厅科学技术研究重点项目（16B320008）；河南省教育厅高等学校重点科研项目（18B310013）