目的 探讨布美他尼联合雷米普利治疗慢性充血性心力衰竭的临床疗效。方法 选取2018年1月—2019年1月洛阳市第六人民医院收治的102例慢性充血性心力衰竭患者，随机分为对照组和治疗组，每组各51例。对照组口服雷米普利片，最初剂量是1.25 mg/次，1次/d，根据病情可增加剂量，最大剂量是10 mg/d。治疗组在对照组治疗基础上静脉滴注布美他尼注射液，2.0 mg同0.9%氯化钠注射液250 mL液溶解，静脉滴注不短于30 min，1次/d。。两组均治疗2周。观察两组的临床疗效，比较两组治疗前后心功能指标、血清学指标、MLHFQ量表评分和6 min步行距离（6WMT）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80.39%、96.08%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组左室舒张末期内经（LVEDD）、左心室收缩末期内径（LVESD）、左心室收缩末期容积（LVESV）都较治疗前显著降低，而左心室射血分数（LVEF）显著升高，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、LVESV均显著低于对照组，而LVEE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）、miR-423-5p、胱抑素C（Cys-C）、高迁移率蛋白1（HMGB1）、可溶性晚期糖基化终末产物受体（sRAGE）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，治疗组这些血清学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MLHFQ评分较治疗前均显著降低，而6 min步行距离（6WMT）均显著增加，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MLHFQ评分显著低于对照组，而6WMT显著高于对照组，两组比较差异具有统计学意义（P<0.05）。结论 布美他尼联合雷米普利治疗慢性充血性心力衰竭具有较好的临床疗效，可有效改善患者心功能，降低血清学指标，提高患者运动耐量及患者生活质量，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of bumetanide combined with ramipril in treatment of chronic congestive heart failure. Methods Patients (102 cases) with chronic congestive heart failure in Luoyang Sixth People's Hospital from January 2018 to January 2019 were randomly divided into control (51 cases) and treatment (51 cases) groups. Patients in the control group were po administered with Ramipril Tablets, the initial dosage was 1.25 mg/time, once daily. The dosage can be increased according to the condition, and the maximum dosage was 10 mg/d. Patients in the treatment group were iv administered with Bumetanide Injection on the control group, and 2.0 mg was dissolved in 0.9% sodium chloride injection 250 mL, and intravenous infusion should not be shorter than 30 min. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the changes of cardiac function indexes, serological indexes, MLHFQ scale score and 6WMT in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 80.39% and 96.08%, respectively, and there were differences between two groups (P<0.05). After treatment, LVEDD, LVESD, and LVESV in two groups were significantly decreased, but LVEF was significantly increased, and there were differences in the same group (P<0.05). After treatment, LVEDD, LVESD, and LVESV 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, miR-423-5p, Cys-C, HMGB1, and sRAGE in two groups were significantly decreased, and there were differences in the same group (P<0.05). After treatment, those serological indexes in the treatment group were lower than those in the control group, and there were differences between two groups (P<0.05). After treatment, MLHFQ scale score in two groups were significantly decreased, but 6WMT was significantly increased, and there were differences in the same group (P<0.05). After treatment, MLHFQ scale score in the treatment group were lower than those in the control group, but 6WMT was higher than that in the control group, and there were differences between two groups (P<0.05). Conclusion Bumetanide combined with ramipril has significant effect in treatment of chronic congestive heart failure, and can effectively improve patients' cardiac function, and also can reduce serological indexes, improve patients' exercise tolerance and patients' life quality, which has a certain clinical application value.