目的 探讨心宝丸联合米力农治疗终末期心力衰竭的临床效果。方法 选取2016年3月-2019年3月延安大学附属医院收治的96例终末期心力衰竭患者，随机分为对照组和治疗组，每组各48例。对照组静脉滴注米力农注射液，负荷量50 μg/kg，缓慢静脉注射（>10 min）；继以0.50 μg/（kg·min）静脉点滴维持，每日最大剂量不超过1.13 mg/kg。治疗组在对照组治疗基础上口服心宝丸，6丸/次，3次/d。两组均连续治疗5 d。观察两组的临床疗效，比较两组治疗前后心功能指标、血流动力学指标、血清学指标和中性粒细胞（NEUT）与淋巴细胞（LYM）比值（NLR）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77.1%、91.7%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组左心室收缩、舒张末期内径（LVESD和LVEDD）值均显著小于治疗前，而左室射血分数（LVEF）值均显著增高，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LVESD、LVEDD值低于对照组，而LVEF高于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组每搏输出量（SV）、心脏收缩力指数（HI）均较治疗前显著增加，而舒张功能指数（O/C）、肺动脉楔压（PAWP）、总外周阻力（TPR）均显著减小，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SV、HI值高于对照组，而O/C、PAWP、TPR值低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组血清B型利钠肽（BNP）、可溶性生长刺激表达基因2蛋白（sST2）、C反应蛋白（CRP）、外周血NLR均较治疗前显著下降，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组血清学指标和NLR均显著低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 心宝丸联合米力农治疗终末期心力衰竭具有较好的临床疗效，有助于逆转患者心室重塑，增强心脏功能，改善血流动力学状态，减轻机体炎症反应，具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Xinbao Pills combined with milrinone in treatment of end-stage heart failure. Methods Patients (96 cases) with end-stage heart failure in Yanan University Affiliated Hospital from March 2016 to March 2019 were randomly divided into control (48 cases) and treatment (48 cases) groups. Patients in the control group were iv administered with Milrinone Injection, load capacity was 50 μg/kg, slowly intravenous injection (> 10 min), and the maximum daily dosage was no more than 1.13 mg/kg following intravenous drip maintenance of 0.50 μg/(kg·min). Patients in the treatment group were po administered with Xinbao Pills on the basis of the control group, 6 pills/time, three times daily. Patients in two groups were treated for 5 d. After treatment, the clinical efficacy was evaluated, and the changes of cardiac function indexes, hemodynamic indexes, serological indexes and NLR in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 77.1% and 91.7%, respectively, and there were differences between two groups (P<0.05). After treatment, LVESD and LVEDD in two groups were significantly decreased, but LVEF was significantly increased, and there were differences in the same group (P<0.05). After treatment, LVESD and LVEDD in the treatment group were lower than those in the control group, but LVEF was higher than those in the control group, and there were differences between two groups (P<0.05). After treatment, SV and HI in two groups were significantly increased, but O/C, PAWP, and TPR was significantly decreased, and there were differences in the same group (P<0.05). After treatment, SV and HI in the treatment group were higher than those in the control group, but O/C, PAWP, and TPR were lower than those in the control group, and there were differences between two groups (P<0.05). After treatment, BNP, sST2, CRP, and NLR in two groups were significantly decreased, and there were differences in the same group (P<0.05). After treatment, serological indexes and NLR in the treatment group were lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Xinbao Pills combined with milrinone has significant effect in treatment of end-stage heart failure, and can help reverse ventricular remodeling in patients, and enhance cardiac function, improve hemodynamic status, and reduce body inflammation, which has a certain clinical application value.

R971