目的 探讨补益强心片联合沙库巴曲缬沙坦治疗慢性心力衰竭的临床效果。方法 选取2020年7月—2021年8月蚌埠医学院第二附属医院收治的98例慢性心力衰竭患者，按随机数字表法分成对照组和治疗组，每组各49例。对照组口服沙库巴曲缬沙坦钠片，100 mg/次，2次/d。治疗组在对照组基础上口服补益强心片，4片/次，3次/d。两组均连续治疗4周。观察两组的临床疗效，比较治疗前后两组超声心动图指标[左室射血分数（LVEF）、左心房容积指数（LAVI）、二尖瓣舒张期血流E峰与A峰比值（E/A）]，运动耐力[6 min步行距离（6MWD）]和生活质量状况，血液流变学指标[血浆黏度（PV）、红细胞聚集指数（EAI）、全血高切黏度（HBV）]，血清N末端B型利钠肽原（NT-proBNP）、白细胞介素-6（IL-6）、基质金属蛋白酶-9（MMP-9）和内皮素-1（ET-1）水平。结果 治疗后，治疗组患者总有效率是95.9%，较对照组83.7%显著提高（P＜0.05）。治疗后，两组LVEF、E/A比治疗前均显著升高，LAVI则均显著降低（P＜0.05）；且均以治疗组改善更显著（P＜0.05）。治疗后，两组6MWD均较治疗前显著延长，明尼苏达心功能不全生命质量量表（MLHFQ）评分则均较治疗前显著减少（P＜0.05）；但均以治疗组改善更显著（P＜0.05）。治疗后两组PV、EAI、HBV均显著低于治疗前（P＜0.05）；但均以治疗组降低更显著（P＜0.05）。治疗后，两组血清NT-proBNP、IL-6、MMP-9和ET-1水平均显著低于治疗前（P＜0.05）；且均以治疗组下降更显著（P＜0.05）。结论 补益强心片联合沙库巴曲缬沙坦治疗慢性心力衰竭具有较好的临床疗效，可显著改善患者心功能，并能提高运动耐力和生活质量，纠正机体血液流变学异常，减轻心肌损伤和心室重构，延缓病情进展，且具有较好的安全性，值得临床推广应用。

Objective To investigate the clinical effect of Buyiqiangxin Tablets combined with sacubitril valsartan sodium in treatment of chronic heart failure.Methods A total of 98 patients with chronic heart failure admitted to The Second Affiliated Hospital of Bengbu Medical College from July 2020 to August 2021 were selected and divided into control and treatment groups with 49 cases in each group according to the random number table method.Patients in the control group were po administered with Sacubitril Valsartan Sodium Tablets,100 mg/time,twice daily.Patients in the treatment group were po administered with Buyiqiangxin Tablets on the basis of the control group,4 tablets/time,three times daily.Both groups were treated for 4 weeks.The clinical efficacy of the two groups was observed.The echocardiographic indicators[left ventricular ejection fraction (LVEF),left atrial volume index (LAVI),mitral diastolic blood flow E-peak to A-peak ratio (E/A)]before and after treatment were compared between the two groups,and 6-minute walk Distance (6MWD),Minnesota Heart Failure Quality of Life Scale (MLHFQ) score,hemorheological indices[plasma viscosity (PV),erythrocyte aggregation index (EAI),whole blood high shear viscosity (HBV)],serum N-terminal Pro-B-type natriuretic peptide (NT-proBNP),interleukin-6(IL-6),matrix metalloproteinase-9(MMP-9) and endothelin-1(ET-1) levels was compared.Results After treatment,the total effective rate of the treatment group was 95.9%,which was significantly higher than that of the control group (83.7%)(P<0.05).After treatment,LVEF and E/A in the two groups were significantly increased compared with those before treatment,while LAVI was significantly decreased (P<0.05).The improvement was more significant in the treatment group (P<0.05).After treatment,the 6MWD of the two groups was significantly longer than that before treatment,and the Minnesota Heart Failure Quality of Life Scale (MLHFQ) score was significantly lower than that before treatment (P<0.05).However,the improvement was more significant in the treatment group (P<0.05).After treatment,PV,EAI and HBV in the two groups were significantly lower than those before treatment (P<0.05).However,the reduction was more significant in the treatment group (P<0.05).After treatment,the serum levels of NT-probNP,IL-6,MMP-9 and ET-1 in the two groups were significantly lower than those before treatment (P<0.05).The decrease was more significant in the treatment group (P<0.05).Conclusion Buyiqiangxin Tablets combined with sacubitril valsartan sodium has a good clinical effect in treatment of chronic heart failure,and can significantly improve the cardiac function of patients,improve exercise endurance and life quality,correct the abnormal hemorheology of the body,reduce myocardial injury and ventricular remodeling,delay the progression of the disease,and has good safety,which is worthy of clinical application.

R972

安徽省高校自然科学项目(KJ2018A0242)