目的 探討注射用丹參多酚酸聯合阿托伐他汀治療缺血性腦卒中合并冠心病的療效及對患者血脂、血管內皮功能和炎癥因子的影響。方法 回顧性納入2018年6月—2020年6月于濮陽市安陽地區(qū)醫(yī)院心內科收治的缺血性腦卒中合并冠心病患者124例，根據治療方法不同將患者分為對照組和觀察組，每組各62例。兩組患者入院均采取抗血小板聚集、調脂、擴張冠狀動脈、吸氧、控制腦水腫、降顱內壓、改善微循環(huán)、維持水電解質平衡及保護腦神經等常規(guī)治療。對照組在常規(guī)治療基礎上給予阿托伐他汀鈣片，20 mg/次，每日1次；觀察組在對照組基礎上給予注射用丹參多酚酸0.13 g溶于250 mL0.9%氯化鈉注射液中，靜脈滴注，每日1次。兩組治療療程均為14 d。比較兩組臨床療效；對比治療前與治療14 d后兩組患者日常生活能力（ADL）評分和美國國立衛(wèi)生研究院卒中量表（NIHSS）評分、血脂、血管內皮功能相關指標和炎癥因子的變化。結果 觀察組總有效率（93.55%）顯著高于對照組（70.97%），組間差異顯著（P<0.05）。治療后兩組ADL評分、高密度脂蛋白-膽固醇（HDL-C）水平、血清一氧化氮（NO）和血管內皮生長因子（VEGF）水平均較治療前顯著升高（P<0.05），而NIHSS評分、低密度脂蛋白-膽固醇（LDL-C）、三酰甘油（TG）和總膽固醇（TC）水平、內皮素-1（ET-1）水平、腫瘤壞死因子α（TNF-α）、高敏C-反應蛋白（hs-CRP）和白細胞介素-6（IL-6）水平較治療前顯著降低（P<0.05）；觀察組治療14 d后ADL評分、HDL-C水平顯著高于對照組（P<0.05），而NIHSS評分、LDL-C、TG和TC水平均顯著低于對照組（P<0.05）；觀察組治療14 d后血清NO和VEGF水平顯著高于對照組（P<0.05），而ET-1水平顯著低于對照組（P<0.05）；觀察組治療14 d后血清TNF-α、hs-CRP和IL-6水平顯著低于對照組（P<0.05）。結論 注射用多酚酸聯合阿托伐他汀治療缺血性腦卒中合并冠心病療效良好，且可改善患者血脂紊亂及血管內皮功能紊亂狀態(tài)，并減輕炎癥反應。

Objective To investigate the efficacy of Salvianolic Acid for Injection combined with atorvastatin in the treatment of ischemic stroke complicated with coronary heart disease and its effects on blood lipid, vascular endothelial function and inflammatory factors. Methods Total 124 patients with ischemic stroke and coronary heart disease treated in the department of internal medicine-cardiovascular of Anyang District Hospital of Puyang City from June 2018 to June 2020 were retrospectively included. According to different treatment methods, the patients were divided into control group and observation group, with 62 cases in each group. Patients in both groups were treated with routine treatment such as anti platelet aggregation, lipid-lowering, coronary artery expansion, oxygen inhalation, control of brain edema, reduction of intracranial pressure, improvement of microcirculation, maintenance of water electrolyte balance and protection of cerebral nerves. On the basis of routine treatment, patients in the control group were given Atorvastatin Calcium Tablets, 20 mg/time, once a day. On the basis of the control group, patients in the observation group were given 0.13 g Salvianolic Acid for Injection dissolved in 250 mL of 0.9% sodium chloride injection, intravenous drip once a day. The treatment course of both groups was 14 days. The clinical effects of the two groups were compared, the changes of activity of daily living (ADL) score, National Institutes of Health Stroke Scale (NIHSS) score, blood lipid, vascular endothelial function and inflammatory factors were compared between the two groups before treatment and 14 days after treatment. Results The total effective rate of the observation group (93.55%) was significantly higher than that of the control group (70.97%). There was significant difference between the groups (P<0.05). After treatment, ADL score, high density lipoprotein cholesterol (HDL-C), serum nitric oxide (NO) and vascular endothelial growth factor (VEGF) in two groups were significantly higher than those before treatment (P<0.05), while NIHSS score, low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and total cholesterol (TC), endothelin-1 (ET-1) and tumor necrosis factor α (TNF-α), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in two groups were significantly lower than those before treatment (P<0.05). The ADL score and HDL-C level in the observation group were significantly higher than those in the control group after 14 days of treatment (P<0.05), while the NIHSS score, LDL-C, TG and TC levels were significantly lower than those in the control group (P<0.05). The levels of serum NO and VEGF in the observation group were significantly higher than those in the control group after 14 days of treatment (P<0.05). The level of ET-1 in the observation group was significantly lower than that in the control group (P<0.05). The levels of hsCRP and IL-6 in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Salvianolic Acid for Injection combined with atorvastatin is effective in the treatment of ischemic stroke complicated with coronary heart disease, and can improve the disorder of blood lipid and vascular endothelial function, and reduce the inflammatory reaction.

R971