目的 探讨参附注射液联合依诺肝素钠治疗急性心肌梗死并心力衰竭的疗效。方法 选择2016年8月—2018年5月铜川市人民医院治疗的334例急性心肌梗死并心力衰竭患者作为研究对象，随机将其分为观察组（174例）与对照组（160例）。对照组患者使用注射用依诺肝素钠，75岁以下患者起始静脉负荷30 mg，之后每12 h皮下注射1 mg/kg；75岁以上患者直接每12 h皮下注射0.75 mg/kg。观察组在对照组的基础上静脉滴注参附注射液40 mL，1次/d。两组均连续治疗10 d后评价疗效。比较两组的心肌酶谱、超声心动图检查、血浆氨基末端前体脑钠肽（NT-proBNP）、内皮素-1（ET-1）改善情况及30 d内的主要心脏事件（MACE）和出血并发症发生情况。结果 治疗后，两组天冬氨酸氨基转移酶（AST）、肌酸激酶MB同工酶（CK-MB）、α-羟丁酸脱氢酶（α-HBDH）均显著下降（P<0.05），观察组显著低于对照组（P<0.05）。治疗后，两组LVEF显著升高，LVDd均明显降低（P<0.05），而对照组CO、E/A无明显改善，观察组以上指标均显著优于对照组（P<0.05）。治疗后，两组血浆NT-proBNP、ET-1水平均显著下降（P<0.05），观察组下降显著优于对照组（P<0.05）。观察组MACE发生率显著低于对照组（P<0.05）。两组出血并发症比较无统计学意义。结论 急性心肌梗死并心力衰竭使用依诺肝素钠抗凝出血并发症少，安全性高，同时加用参附注射液可显著改善心肌酶谱，改善左心室功能，提高预后。

Objective To investigate the effect of Shenfu Injection combined with enoxaparin sodium in treatment of acute myocardial infarction with heart failure. Methods Patients (334 cases) with acute myocardial infarction complicated with heart failure in Tongchuan People's Hospital from August 2016 to May 2018 were randomly divided into observation group (174 cases) and control group (160 cases). Patients in the control group were given Enoxaparin Sodium for Injection. Patients under 75 years of age were given 30 mg intravenous load and subcutaneously injected 1 mg/kg every 12 h. Patients over 75 years of age were given 0.75 mg/kg subcutaneously every 12 h. Patients in the observation group were iv administered with Shenfu Injection 40 mL on the basis of the control group, once daily. Efficacy was evaluated after continuous treatment for 10 d in both groups. The improvement of myocardial enzymes, echocardiography, plasma NT-proBNP and ET-1 levels, MACE, and bleeding complications within 30 days were compared between two groups. Results After treatment, the levels of AST, CK-MB and α-HBDH in two groups were significantly decreased (P<0.05), while those in the observation group were significantly lower than those in the control group (P<0.05). After treatment, LVEF were significantly increased in two groups, LVDd were decreased (P<0.05), but CO and E/A did not improve significantly in the control group. The above indexes in the observation group were significantly better than those in the control group (P<0.05). After treatment, the levels of NT-proBNP and ET-1 in plasma of the two groups were significantly decreased (P<0.05), and the levels of NT-proBNP and ET-1 in the observation group was significantly lower than that in the control group (P<0.05). The incidence of MACE in the observation group was significantly lower than that in the control group (P<0.05).There was no significant difference in bleeding complications between the two groups. Conclusion Enoxaparin sodium for anticoagulant bleeding in patients with acute myocardial infarction and heart failure has few complications and high safety. In addition, shenfu injection can significantly improve myocardial enzyme profile, improve left ventricular function and improve prognosis.