目的 探讨冠心康胶囊联合盐酸伊伐布雷定片治疗顽固性心力衰竭的临床疗效。方法 选取2020年5月—2022年6月在衡水市中医医院就诊的128例顽固性心力衰竭患者，根据随机数字表法将所有患者分为对照组和治疗组，每组各64例。对照组口服盐酸伊伐布雷定片，5 mg/次，2次/d。治疗组在对照组基础上口服冠心康胶囊，4粒/次，3次/d。两组连续治疗3个月。观察两组的临床疗效，比较两组患者心功能指标和血清因子水平。结果 治疗后，治疗组患者的总有效率为92.19%，明显高于对照组的总有效率79.69%，差异有显著意义（P＜0.05）。治疗后，两组的左心室射血分数（LVEF）高于治疗前，左心室舒张末期后壁厚度（LVPWT）低于治疗前（P＜0.05）；治疗组的LVEF高于对照组，LVPWT低于对照组差异有统计学意义（P＜0.05）。治疗后，两组的血清血管紧张素-2（Ang-2）、血管紧张素转换酶2（ACE2）、N末端脑钠肽前体（NT-proBNP）水平明显降低（P＜0.05），且治疗组血清Ang-2、ACE2、NT-proBNP水平明显低于对照组（P＜0.05）。结论 冠心康胶囊联合盐酸伊伐布雷定片治疗顽固性心力衰竭的疗效确切，可改善心功能，调节血清Ang-2、ACE2、NT-proBNP水平，安全性较好。

Objective To investigate the clinical efficacy of Guanxinkang Capsules combined with Ivabradine Hydrochloride Tablets in treatment of refractory heart failure. Methods Patients (128 cases) with refractory heart failure in Hengshui Hospital of Traditional Chinese Medicine from May 2020 to June 2022 were divided into control and treatment groups according to the random number table method, and each group had 64 cases. Patients in the control group were po administered with Ivabradine Hydrochloride Tablets, 5 mg/time, twice daily. Patients in the treatment group were po administered with Guanxinkang Capsules on the basis of the control group, 4 grains/time, three times daily. Patients in two groups were treated for 3 months. After treatment, the clinical efficacies were evaluated, and cardiac function indexes and serum factor levels in two groups were compared. Results After treatment, the total effective rate of patients in the treatment group was 92.19%, which was significantly higher than the total effective rate of 79.69% in the control group, with significant difference between two groups (P < 0.05). After treatment, LVEF in two groups was higher than before treatment, but LVPWT in two groups was lower than before treatment (P < 0.05). LVEF in the treatment group was higher than that in the control group, but LVPWT in the treatment group was lower than that in the control group (P < 0.05). After treatment, the serum levels of Ang-2, ACE2, and NT-proBNP in two groups were significantly reduced (P < 0.05), and the serum levels of Ang-2, ACE2, and NT-proBNP in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Guanxinkang Capsules combined with Ivabradine Hydrochloride Tablets has clinical curative effect in treatment of refractory heart failure, can improve heart function and regulate the serum levels of Ang-2, ACE2, and NT-proBNP, with good safety.

R972

衡水市科技计划项目（2021014067Z）