目的 探讨参附强心丸联合左西孟旦治疗顽固性心力衰竭的临床疗效。方法 选取2017年5月-2018年5月在青岛市第九人民医院进行治疗的84例顽固性心力衰竭患者，根据用药的差别分为对照组和治疗组，每组各42例。对照组静脉滴注左西孟旦注射液，首次剂量是12 μg/kg，滴注时间控制在10 min，之后按0.1 μg/（kg·min）的维持剂量静脉泵入，连续治疗24 h。治疗组在对照组治疗基础上口服参附强心丸，6 g/次，3次/d。两组均连续治疗4 d。观察两组的临床疗效，比较两组治疗前后心功能指标、心肌损伤标志物、心肌酶学指标和心肌纤维化指标的变化情况。结果 治疗后，对照组和治疗组的总有效率分别是80.95%、95.24%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组左心室舒张末内径（LVEDD）、左心室收缩末期内径（LVESD）均较治疗前显著降低，而左室射血分数（LVEF）均显著增高，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组LVEDD、LVESD显著低于对照组，而LVEE显著高于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组血清N末端B型钠尿肽原（NT-proBNP）、肌钙蛋白T（cTnT）、心脏型脂肪酸结合蛋白（H-FABP）、肌酸激酶同工酶（CK-MB）均较治疗前显著降低，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组这些指标显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者Ⅰ型胶原羧基末端肽（ICTP）、Ⅲ型前胶原氨基末端肽（PⅢNP）、结缔组织生长因子（CTGF）、透明质酸（HA）、层粘蛋白（LN）水平均明显降低，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组这些心肌纤维化指标显著低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 参附强心丸联合左西孟旦治疗顽固性心力衰竭具有较好的临床疗效，可有效改善患者心功能，降低心肌酶学指标，抑制心肌纤维化进程，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Shenfu Qiangxin Pills combined with levosimendan in treatment of refractory heart failure. Methods Patients (84 cases) with refractory heart failure in the Ninth People's Hospital of Qingdao from May 2017 to May 2018 were divided into control (42 cases) and treatment group (42 cases) according to the difference of medication. Patients in the control group were iv administered with Levosimendan Injection, the first dosage was 12 μg/kg, the infusion time was controlled at 10 min. And then the maintenance dosage of 0.1μg/(kg·min) was intravenously pumped, and the treatment lasted for 24 h. Patients in the treatment group were po administered with Shenfu Qiangxin Pills on the basis of the control group, 6 g/time, three times daily. Patients in two groups were treated for 4 d. After treatment, the clinical efficacy was evaluated, and the changes of cardiac function indexes, myocardial injury markers, myocardial enzyme indexes and myocardial fibrosis indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 80.95% and 95.24%, respectively, and there were differences between two groups (P < 0.05). After treatment, LVEDD and LVESD in two groups were significantly decreased, but LVEF was significantly increased, and there were differences in the same group (P < 0.05). After treatment, the LVEDD and LVESD in the treatment group were lower than those in the control group, but LVEF was higher than that in the control group, and there were differences between two groups (P < 0.05). After treatment, NT-proBNP, cTnT, H-FABP, and CK-MB were significantly decreased, and there were differences in the same group (P < 0.05). After treatment, these indicators in the treatment group were lower than those in the control group, and there were differences between two groups (P < 0.05). After treatment, ICTP, PⅢNP, CTGF, HA, and LN were significantly decreased, and there were differences in the same group (P < 0.05). After treatment, these indicators of myocardial fibrosis in the treatment group were lower than those in the control group, and there were differences between two groups (P < 0.05). Conclusion Shenfu Qiangxin Pills combined with levosimendan has significant effect in treatment of refractory heart failure, and can effectively improve the cardiac function, and reduce myocardial enzyme indexes and inhibit the process of myocardial fibrosis, which has a certain clinical application value.