目的 探讨冻干重组人脑利钠肽联合福辛普利钠片治疗顽固性心力衰竭的临床疗效。方法 选择2018年10月—2019年11月在天津市第四中心医院治疗的74例顽固性心力衰竭患者，采用随机数字表法分为对照组和治疗组，每组各37例。对照组口服福辛普利钠片，初次给予10 mg，1次/d，若耐受，可逐渐增至40 mg，1次/d。治疗组在对照组基础上静脉给予冻干重组人脑利钠肽，初始剂量1.5μg/kg静脉推注3～5 min，然后以0.007 5 μg/（kg·min）静脉滴注。两组患者经7 d治疗。观察两组患者临床疗效，比较治疗前后两组患者心功能指标每搏输出量（SV）、心脏指数（CI）、左室射血分数（LVEF）、左室舒张末期内径（LVEDD），及血清心肌型肌酸激酶同工酶（CK-MB）、氨基末端脑钠肽前体（NT-proBNP）、内皮素-1（ET-1）、半乳糖凝集素-3（Gal-3）、肌钙蛋白T（cTnT）和Ⅲ型前胶原端肽（PⅢNP）水平。结果 治疗后，对照组总有效率为70.27%，显著低于治疗组的89.19%（P<0.05）。治疗后，两组患者SV、CI和LVEF显著升高，而LVEDD显著降低（P<0.05），且治疗组心功能指标明显好于对照组（P<0.05）。治疗后，两组血清NT-proBNP、Gal-3、cTnT、PⅢNP、ET-1和CK-MB水平均显著降低（P<0.05），且治疗组降低最明显（P<0.05）。结论 冻干重组人脑利钠肽联合福辛普利钠片治疗顽固性心力衰竭可有效改善患者心功能，促进心肌酶学指标和心肌损伤指标的下降，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Lyophilized Recombinant Human Brain Natriuretic Peptide combined with fosinopril sodium in treatment of refractory heart failure. Methods Patients (74 cases) with refractory heart failure in Tianjin 4th Central Hospital from October 2018 to November 2019 were randomly divided into control and treatment groups by random number table method, and each group had 37 cases. Patients in the control group were po administered with Fosinopril Sodium Tablets, the initial dose was 10 mg/d, once daily, and could gradually increased to 40 mg if patients were tolerant. Patients in the treatment group iv administered with Lyophilized Recombinant Human Brain Natriuretic Peptide on the basis of the control group, the initial intravenous injection dose was 1.5 μg/kg for 3 to 5 minutes, then intravenously dripped with 0.007 5 μg/(kg·min). Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the cardiac function indexes of SV, CI, LVEF and LVEDD, and the serum levels of NT-proBNP, Gal-3, cTnT, PⅢNP, ET-1 and CK-MB in two groups before and after treatment were compared. Results After treatment, the clinical effective rate in the control group was 70.27%, which was significantly lower than 89.19% in the treatment group (P<0.05). After treatment, SV, CI and LVEF in two groups were significantly increased, while LVEDD were significantly decreased (P<0.05), and the cardiac function indexes in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the serum levels of NT-proBNP, Gal-3, cTnT, PIII NP, ET-1, and CK-MB were significantly decreased in two groups (P<0.05), especially in the treatment group (P<0.05). Conclusion Lyophilized Recombinant Human Brain Natriuretic Peptide combined with fosinopril sodium in treatment of refractory heart failure can effectively improve the cardiac function and promote the decrease of myocardial enzyme index and myocardial injury index, which has a certain clinical application value.

R972