目的 考察尿激酶静脉溶栓后序贯应用注射用丹参多酚酸治疗急性缺血性脑卒中的临床疗效和安全性。方法 回顾性选取2018年3月—2020年5月安阳市人民医院收治的急性缺血性脑卒中患者202例为研究对象，根据治疗方法分为对照组（n=99）和联合组（n=103），对照组于患者发病6 h内应用注射用尿激酶静脉溶栓治疗，用药剂量为2.0×10⁴ U/kg，总剂量不超过1.5×10⁶ U，配以0.9%氯化钠注射液100 mL，30 min内持续静脉泵入完毕，后续仅给于基础治疗。联合组在对照组治疗基础上，于静脉溶栓24 h后序贯应用注射用丹参多酚酸0.13 g配以0.9%氯化钠注射液250 mL，静脉滴注，1次/d，疗程为14 d。两组患者均在尿激酶溶栓24 h后查头颅CT排除出血转化，给予规范应用抗血小板聚集、调脂、控制危险因素等基础性治疗。评估治疗后7、14、90 d两组患者美国国立卫生研究院卒中量表（NIHSS）评分及改良Rankin量表（mRS）评分，比较两组90 d mRS评分以及治疗14 d脑出血及症状性脑出血率，并采用多因素Logistic回归分析影响预后的危险因素。结果 两组患者治疗后7 d NIHSS评分无统计学差异（P>0.05）。联合组治疗后14、90 d的NIHSS评分均低于对照组，差异具有统计学意义（P<0.05）。联合组较对照组90 d预后良好率高，差异具有统计学差异（P<0.05）。两组患者治疗后14 d出血率、症状性出血率均无统计学差异（P>0.05）。多因素Logistic回归分析显示，溶栓前NHISS评分≤7分（OR=0.177，95% CI 0.084～0.370，P<0.05）、发病至溶栓时间≤270 min（OR=0.342，95% CI 0.149～0.785，P<0.05）、使用注射用丹参多酚酸（OR=0.288，95% CI 0.143～0.580，P<0.05）是预后良好的保护因素。结论 尿激酶溶栓后序贯应用注射用丹参多酚酸治疗急性缺血性脑卒中安全有效，可以改善患者早期临床症状，并促进远期神经功能康复、改善远期预后。

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