目的 探讨麝香保心丸联合酚妥拉明治疗慢性肺源性心脏病急性加重期的临床效果。方法 选取2017年1月—2018年6月亳州市人民医院收治的72例慢性肺源性心脏病急性加重期患者，随机分为对照组和治疗组，每组各36例。对照组静脉滴注甲磺酸酚妥拉明注射液，20 mg加入5%葡萄糖液250 mL中均匀混合后缓慢给药，1次/d。治疗组在对照组基础上口服麝香保心丸，2丸/次，3次/d。两组均连续治疗7 d。观察两组的临床疗效，比较两组治疗前后血气指标、高凝状态指标、超声心动图指标、肺功能指标、内皮素-1（ET-1）和C反应蛋白（CRP）的变化情况。结果 治疗后，对照组和治疗组的总有效率分别是77.8%、94.4%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组动脉血氧（pO₂）较治疗前均显著升高，而二氧化碳分压（pCO₂）、纤维蛋白原（FIB）、D-二聚体（D-D）均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，治疗组pO₂值高于对照组，而pCO₂、FIB、D-D均低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组右心室内径（RVD）、肺动脉收缩压（PASP）较治疗前均显著降低，而右室面积变化分数（FAC）、E峰减速时间（EDT）均显著增高，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，治疗组RVD、PASP显著低于对照组，而FAC、EDT高于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组第1秒用力呼气容积（FEV1）、最大呼气中段流量占预计值百分比（MMEF% pred）较治疗前均显著升高，而ET-1、CRP均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，治疗组FEV1、MMEF% pred显著高于对照组，而ET-1、CRP低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 麝香保心丸联合酚妥拉明治疗慢性肺源性心脏病急性加重期的整体疗效显著，有利于纠正患者体内缺氧和二氧化碳潴留，改善血液高凝状态，保护心肺功能，具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Shexiang Baoxin Pills combined with phentolamine in treatment of acute exacerbations of chronic pulmonary heart disease. Methods Patients (72 cases) with acute exacerbations of chronic pulmonary heart disease in Bozhou People's Hospital from January 2017 to June 2018 were randomly divided into control (36 cases) and treatment (36 cases) groups. Patients in the control group were iv administered with Phentolamine Mesilate Injection, 20 mg was added to 5% glucose solution 250 mL and mixed evenly, once daily. Patients in the treatment group were po administered with Shexiang Baoxin Pills on the basis of the control group, 2 pills/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the changes of blood gas indexes, hypercoagulability indexes, echocardiography indexes, pulmonary function indexes, ET-1 and CRP in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 77.8% and 94.4%, respectively, and there were differences between two groups (P<0.05). After treatment, pO₂ in two groups were significantly increased, but pCO₂, FIB, and D-D were significantly decreased, and there were differences in the same group (P<0.05). After treatment, the pO₂ in the treatment group were higher than those in the control group, but pCO₂, FIB, and D-D were lower than those in the control group, and there were differences between two groups (P<0.05). After treatment, RVD and PASP in two groups were significantly decreased, but FAC and EDT were significantly increased, and there were differences in the same group (P<0.05). After treatment, the RVD and PASP in the treatment group were lower than those in the control group, but FAC and EDT were higher than those in the control group, and there were differences between two groups (P<0.05). After treatment, FEV1 and MMEF%pred in two groups were significantly increased, but ET-1 and CRP were significantly decreased, and there were differences in the same group (P<0.05). After treatment, the FEV1 and MMEF%pred in the treatment group were higher than those in the control group, but ET-1 and CRP were lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Shexiang Baoxin Pills combined with phentolamine has significant effect in treatment of acute exacerbations of chronic pulmonary heart disease, and is helpful to correct hypoxia and carbon dioxide retention in patients, and improve blood hypercoagulability, and protect cardiopulmonary function, which has a certain clinical application value.