目的 探讨左西孟旦联合氢氯噻嗪治疗重症心力衰竭的临床疗效。方法 选取2020年7月—2023年7月复旦大学附属中山医院青浦分院重症监护室收治的100例重症心力衰竭患者，按随机数字法将所有患者分为对照组和治疗组，每组各50例。对照组患者口服氢氯噻嗪片，50 mg/次，2次/d。治疗组在对照组的治疗基础上静脉滴注左西孟旦注射液，5 mL加入5%葡萄糖注射液500 mL中。两组用药7 d。观察两组的临床疗效和临床症状改善时间，比较两组治疗前后心功能指标、生活质量综合评定问卷调查表（CQOLI-74）评分和血清细胞因子水平的变化情况。结果 治疗后，治疗组总有效率是98.0%，显著高于对照组的82.0%（P＜0.05）。治疗后，治疗组呼吸困难、乏力、气促、下肢水肿好转时间均短于对照组（P＜0.05）。治疗后，两组左室射血分数（LVEF）、心排血量（CO）、GQOLI-74评分均显著高于同组治疗前（P＜0.05）；治疗后，治疗组LVEF、CO、GQOLI-74评分高于对照组（P＜0.05）。治疗后，两组β型脑钠肽（BNP）、可溶性生长刺激表达基因2蛋白（sST2）、同型半胱氨酸（Hcy）、胱抑素C（CysC）水平均较同组治疗前显著降低（P＜0.05）；治疗后，治疗组BNP、sST2、Hcy、CysC水平低于对照组（P＜0.05）。结论 左西孟旦联合氢氯噻嗪治疗重症心力衰竭有较好的临床疗效，能有效改善患者的临床症状，增强心功能指标，降低机体炎性反应，值得临床借鉴应用。

Objective To explore the clinical study of levosimendan combined with hydrochlorothiazide in treatment of severe heart failure. Methods A total of 100 patients with severe heart failure admitted to the Intensive Care Unit of Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from July 2020 to July 2023 were selected and divided into control group and treatment group by random number method, with 50 cases in each group. Patients in the control group were po administered with Hydrochlorothiazide Tablets, 50 mg/time, twice daily. Patients in the treatment group were iv administered with Levosimendan Injection on the basis of the control group, 5 mL added to 5% glucose injection 500 mL. Both groups were treated for 7 d. The clinical efficacy and improvement time of clinical symptoms in two groups were observed, and the changes of cardiac function index, CQOLI-74 score and serum cytokine level before and after treatment were compared between two groups. Results After treatment, the total effective rate of the treatment group was 98.0%, which was significantly higher than that of control group (82.0%, P＜0.05). After treatment, the improvement time of dyspnea, fatigue, shortness of breath and lower limb edema in treatment group was shorter than that in the control group (P＜0.05). After treatment, left ventricular ejection fraction (LVEF), cardiac output (CO) and GQOLI-74 score in two groups were significantly higher than before treatment (P＜0.05). After treatment, LVEF, CO and GQOLI-74 scores in the treatment group were higher than those in control group (P＜0.05). After treatment, the levels of β-type brain natriuretic peptide (BNP), soluble growth stimulation expression gene-2 protein (sST2), homocysteine (Hcy) and cystatin C (CysC) in two groups were significantly decreased compared with those before treatment (P＜0.05). After treatment, the levels of BNP, sST2, Hcy and CysC in the treatment group were lower than those in control group (P＜0.05). Conclusion Levosimendan combined with hydrochlorothiazide has good clinical effect in treatment of severe heart failure, and can effectively improve the clinical symptoms of patients, enhance the index of cardiac function, reduce the inflammatory response of the body, which is worthy of clinical application.

R972

上海市青浦区卫生健康委员会科研课题计划（QWJ2022-16）