目的 观察沙库巴曲缬沙坦钠片治疗难治性心力衰竭的临床疗效。方法 选取2018年10月—2019年10月在天津市第二医院心内科住院治疗的共84例难治性心力衰竭患者为研究对象，入选患者按照随机数字法分为对照组44例、治疗组40例。对照组口服马来酸依那普利片，起始剂量10 mg/次，2次/d，根据血压情况增加到患者能承受的最大剂量。治疗组口服沙库巴曲缬沙坦钠片，起始剂量25～50 mg/次，2次/d，根据血压、患者耐受性逐渐加量，最大剂量400 mg/d。两组患者连续治疗6个月。观察两组的临床疗效，比较两组的心功能指标[左室射血分数（LVEF）、左室舒张末期内径（LVEDD）和左心室后壁厚度（LVPW）]、血清因子[血浆N末端脑钠肽前体（NT-proBNP）、血浆去甲肾上腺素（NE）、血管紧张素Ⅱ（AngⅡ）和醛固酮（ALD）]和明尼苏达生活质量评分（MLHFQ）。结果 治疗后，对照组和治疗组的临床总有效率分别为88.63%、95.00%，两组比较差异有统计学意义（P<0.05）。与治疗前相比，两组的LVEF均显著增高，LVEDD、LVPW均显著降低，差异有统计学意义（P<0.05）；治疗后，治疗组LVEF显著高于对照组，LVEDD、LVPW显著低于对照组，差异有统计学意义（P<0.05）。与治疗前相比，两组血清NT-proBNP、NE、AngⅡ和ALD水平均显著降低，差异有统计学意义（P<0.05）；治疗后，治疗组血清NT-proBNP、NE、AngⅡ、ALD水平均显著低于对照组，差异有统计学意义（P<0.05）。与治疗前相比，对照组与治疗组MLHFQ均显著降低，差异有统计学意义（P<0.05）；治疗后，治疗组MLHFQ显著低于对照组，差异有统计学意义（P<0.05）。结论 沙库巴曲缬沙坦钠片治疗难治性心力衰竭可明显改善患者的临床症状，提高心功能，改善心室重塑，提高生活质量，具有临床推广使用价值。

Objective To observe the clinical efficacy of Sacubitril Valsartan Sodium Tablets in treatment of refractory heart failure. Methods Patients (84 cases) with refractory heart failure in Tianjin 2th Hospital from October 2018 to October 2019 were randomly divided into the control group (44 cases) and the treatment group (40 cases). Patients in the control group were po administered with Enalapril Maleate Tablets, starting dosage 10 mg/time, twice daily, and according to blood pressure, increased to the maximum dose that the patient could bear. Patients in the treatment group were po administered with Sacubitril Valsartan Sodium Tablets, starting dosage 25 — 50 mg/time, twice daily, then according to blood pressure and patient tolerance, the dosage was gradually increased, with a maximum dose of 400 mg/d. Patients in two groups were treated for 6 months. After treatment, the clinical efficacies were evaluated, and cardiac function indexes (LVEF, LVEDD, and LVPW), serum factors (NT-proBNP, NE, AngⅡ, and ALD), and MLHFQ in two groups were compared. Results After treatment, the total clinical effective rate of the control and treatment group was 88.63% and 95.00%, respectively, and there was difference between two groups (P<0.05). After treatment, LVEF in the two groups were significantly increased, but LVEDD and LVPW were significantly decreased, with statistically significant differences (P<0.05). After treatment, LVEF in the treatment group was significantly higher than that in the control group, but LVEDD and LVPW in the treatment group were significantly lower than that in the control group, with statistically significant differences (P<0.05). After treatment, the serum levels of NT-proBNP, NE, Ang Ⅱ, and ALD of the two groups were significantly decreased, and the difference was statistically significant (P<0.05). After treatment, the serum levels of NT- proBNP, NE, Ang Ⅱ, and ALD of the treatment group were significantly lower than that of the control group, and the difference was statistically significant (P<0.05). After treatment, MLHFQ in two groups were significantly decreased, and the difference was statistically significant (P<0.05). After treatment, MLHFQ in the treatment group was significantly lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion Sacubitril Valsartan Sodium Tablets has clinical curative effect in treatment of refractory heart failure, can significantly improve the clinical symptoms and cardiac function, improve ventricular remodeling and improve the quality of life, which is worthy of clinical application.

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