目的 探讨奥美沙坦酯联合左西孟旦治疗老年难治性心力衰竭患者的临床疗效。方法 选取2022年8月—2024年9月沧州市中心医院收治的86例难治性心力衰竭患者，依据随机数字法将患者分为对照组和治疗组，每组43例。对照组患者静脉滴注左西孟旦注射液，12.5 mg加入0.9%氯化钠注射液200 mL稀释，1次/d。治疗组在对照组的治疗基础上口服奥美沙坦酯片，20 mg/次，1次/d。两组用药14 d。观察临床疗效和临床症状缓解时间，比较两组患者治疗前后6 min步行试验距离（6MWT）、简明健康状况调查量表（SF-36）评分、心功能相关指标、心肌损伤因子及炎性因子水平的变化情况。结果 治疗14 d后，治疗组总有效率是95.35%，显著高于对照组的79.07%（P＜0.05）。治疗14 d后，与对照组对比，治疗组气急、疲乏、发绀、四肢发冷缓解时间均较短（P＜0.05）。治疗后，两组6MWT、ST-36评分均显著增加（P＜0.05）；治疗后，与对照组对比，治疗组6MWT、ST-36评分均较高（P＜0.05）。治疗后，两组患者左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）较治疗前显著降低，而左心室射血分数（LVEF）升高（P＜0.05）；治疗后，与对照组对比，治疗组LVESD、LVEDD指标均较低，LVEF较高（P＜0.05）。治疗后，两组患者长正五聚蛋白-3（PTX-3）、半乳糖凝集素3（galectin-3）、氨基末端脑利钠肽前体（NT-proBNP）、心肌型脂肪酸结合蛋白（H-FABP）水平均较治疗前降低（P＜0.05）；治疗后，与对照组对比，治疗组PTX-3、galectin-3、NT-proBNP、H-FABP水平均较低（P＜0.05）。治疗后，两组转化生长因子β1（TGF-β1）、脂蛋白（a）[LP（a）]、肿瘤坏死因子-α（TNF-α）、白细胞介素-23（IL-23）水平均显著降低（P＜0.05）；治疗后，与对照组对比，治疗组TGF-β1、LP（a）、TNF-α、IL-23水平均较低（P＜0.05）。结论 奥美沙坦酯联合左西孟旦治疗难治性心力衰竭效果明显，能有效改善心功能相关指标，降低机体炎症反应，改善心肌损伤状态，显著提升患者生活质量，值得借鉴与推广。

Objective To investigate the therapeutic effect of olmesartan medoxomil combined with levosimendan in treatment of elderly refractory heart failure. Methods A total of 86 patients with refractory heart failure admitted to Cangzhou Central Hospital from August 2022 to September 2024 were selected and divided into control group and treatment group according to random number method, with 43 cases in each group. Patients in control group were iv administered with Levosimendan Injection, 12.5 mg was diluted with 0.9% sodium chloride injection 200 mL, once daily. Patients in treatment group were po administered with Olmesartan Medoxomil Tablets on the basis of the control group, 20 mg/time, once daily. Both groups were treated for 14 d. The clinical efficacy and the duration of clinical symptom remission were observed, and the changes of 6MWT, SF-36 score, cardiac function related indexes, myocardial injury factors and inflammatory factors before and after treatment were compared between two groups. Results After 14 d of treatment, the total effective rate of the treatment group was 95.35%, which was significantly higher than that of the control group (79.07%, P < 0.05). After 14 d of treatment, the relief time of dyspnea, fatigue, cyanosis and cold limbs in treatment group was shorter than that in control group (P < 0.05). After treatment, 6MWT and ST-36 scores were significantly increased in both groups (P < 0.05). After treatment, 6MWT and ST-36 scores in treatment group were higher than those in control group (P < 0.05). After treatment, LVESD and LVEDD in 2 groups were significantly lower than before treatment, but LVEF was increased (P < 0.05). After treatment, compared with the control group, LVESD and LVEDD indexes in treatment group were lower, but LVEF was higher (P < 0.05). After treatment, the levels of PTX-3, galectin-3, NT-proBNP, and H-FABP in 2 groups were decreased compared with those before treatment (P < 0.05). After treatment, the levels of PTX-3, galectin-3, NT-proBNP and H-FABP in treatment group were lower than those in control group (P < 0.05). After treatment, the levels of TGF-β1, LP (a), TNF-α, and IL-23 were significantly decreased in both groups (P < 0.05). After treatment, the levels of TGF-β1, LP (a), TNF-α and IL-23 in treatment group were lower than those in control group (P < 0.05). Conclusion Olmesartan medoxomil combined with levosimendan has obvious effect in treatment of elderly refractory heart failure, and can effectively improve the related indicators of heart function, reduce the inflammatory response of the body, improve the state of myocardial injury, and significantly improve the quality of life of patients, which is worth learning and promoting.

R972

河北省医学科学研究重点课题计划项目（20220416）；沧州市重点研发课题项目计划（213106015）