目的 探讨利心丸联合盐酸伊伐布雷定片治疗老年稳定性心力衰竭的临床疗效。方法 选取2016年5月-2018年5月在黑龙江省森工总医院治疗的老年稳定性心力衰竭患者152例，根据用药的差别分为对照组（76例）和治疗组（76例）。对照组口服盐酸伊伐布雷定片，5 mg/次，2次/d，经两周治疗后，若静息心率持续大于60次/min，可增至7.5 mg/次，2次/d；若静息心率持续低于50次/min，可下调至2.5mg/次，2次/d；若心率为50~60次/min，则维持5 mg/次，2次/d。治疗组在对照组基础上口服利心丸，9 g/次，3次/d。两组患者均经2周治疗。观察两组患者临床疗效，同时比较治疗前后两组患者左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室收缩末期容积（LVESV）、左室舒张末期内经（LVEDD）、6分钟步行距离（6WMT）、西雅图心绞痛量表（SAQ）积分、GQOLI-74及血清N末端B型钠尿肽原（NT-proBNP）、胱抑素C（Cys-C）、心肌肌钙蛋白T（cTnT）、可溶性晚期糖基化终末产物受体（sRAGE）、内皮素-1（ET-1）、可溶性细胞间黏附分子-1（sICAM-1）、可溶性血管细胞黏附分子-1（sVCAM-1）水平和miR-423-5p。结果 治疗后，对照组和治疗组临床有效率分别为81.58%和97.37%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者LVEE均明显升高（P<0.05），LVESV、LVEDD和LVESD均明显下降（P<0.05），且治疗组患者心功能指标水平明显好于对照组（P<0.05）。治疗后，两组患者6WMT、SAQ积分和GQOLI-74评分均显著升高（P<0.05），且治疗组患者这些评分明显高于对照组（P<0.05）。治疗后，两组患者血清NT-proBNP、Cys-C、cTnT、miR-423-5p、sRAGE、ET-1、sVCAM-1、sICAM-1水平均明显下降（P<0.05），而NO水平明显升高（P<0.05），且治疗组患者这些血清学指标明显好于对照组（P<0.05）。结论 利心丸联合盐酸伊伐布雷定片治疗老年稳定性心力衰竭可有效改善患者心功能，促进血管内皮功能改善，提高患者运动耐量。

Objective To explore the clinical efficacy of Lixin Pills combined with ivabradine in treatment of elderly stable heart failure. Methods Patients (152 cases) with stable heart failure in Heilongjiang Red Cross Sengong General Hospital from May 2016 to May 2018 were divided into control (76 cases) and treatment (76 cases) groups based on different treatments. Patients in the control group were po administered with Ivabradine Hydrochloride Tablets, 5 mg/time, twice daily, the dose increased to 7.5 mg/time if resting heart rate was more than 60 times/min after 2 weeks treatment, and decreased to 2.5 mg/time if resting heart rate was less than 50 times/min, and maintained 5 mg/time if the heart rate was 50-60 times/min. Patients in the treatment group were po administered with Lixin Pills on the basis of the control group, 9 g/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the LVEF, LVESD, LVESV, LVEDD, 6WMT, SAQ, GQOLI-74, and serum levels of NT-proBNP, Cys-C, cTnT, sRAGE, ET-1, sICAM-1, sVCAM-1, and miR-423-5p in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 81.58% and 97.37% respectively, and there were differences between two groups (P<0.05). After treatment, the VLVEE in two groups was significantly increased (P<0.05), but LVESV, LVEDD and LVESD were significantly decreased (P<0.05), and the cardiac function in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the 6WMT, SAQ, and GQOLI-74 scores in groups were significantly increased (P<0.05), and these indexes in the treatment group were significantly higher than those in the control group (P<0.05). After treatment, the serum levels of NT-proBNP, Cys-C, cTnT, sRAGE, ET-1, sVCAM-1, sICAM-1, and miR-423-5p in two groups were significantly decreased (P<0.05), but NO levels were significantly increased (P<0.05), and these indicators level in the treatment group was significantly better than those in the control group (P<0.05). Conclusion Lixin Pills combined with ivabradine in treatment of elderly stable heart failure can effectively improve cardiac function, improve the vascular endothelial function, and improve exercise tolerance.