目的 研究注射用重组人脑利钠肽联合盐酸伊伐布雷定片治疗慢性充血性心力衰竭的临床疗效。方法 选取2016年4月-2018年9月延安大学附属医院收治的204例慢性充血性心力衰竭患者为研究对象，按随机数字表法将患者随机分为对照组和治疗组，每组各102例。对照组口服采用盐酸伊伐布雷定片，初始剂量为2.5 mg/次，2次/d，同时根据患者的心率变化情况对剂量进行调整，但最大剂量不超过7.5 mg/次，2次/d。治疗组在对照组的基础上静脉注射注射用重组人脑利钠肽，以1.5 μg/kg剂量进行静脉冲击，后改为0.007 5 μg/（kg·min）静注维持2 d。所有患者在治疗1个月后评估疗效。观察两组的临床疗效，比较两组的心功能指标、血清炎性因子水平、血清因子水平。结果 治疗后，对照组和治疗组的总有效率分别为69.61%、85.29%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者左室射血分数（LVEF）、每分钟心脏排血量（CO）均显著升高，左室舒张末期压力（LVEDP）显著下降，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组LVEF、CO明显高于对照组，LVEDP明显低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者血清白细胞介素-6（IL-6）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平均显著下降，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组患者血清IL-6、CRP、TNF-α水平均明显低于对照组，两组差异具有统计学意义（P<0.05）。治疗后，两组患者血清脂质运载蛋白-2（LCN-2）、可溶性糖蛋白130（Sgp130）、N-末端B型钠肽原（NT-pro BNP）水平均显著降低，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组患者血清LCN-2、Sgp130、NT-pro BNP水平均明显低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 注射用重组人脑利钠肽联合盐酸伊伐布雷定片治疗慢性充血性心力衰竭具有较好的临床疗效，可改善患者的心功能，降低炎症水平，调节血清因子水平，安全性良好，具有一定的临床推广应用价值。

Objective To study the efficacy of Recombinant Human Brain Natriuretic Peptide for injection combined with Ivabradine Hydrochloride Tablets in treatment of chronic congestive heart failure. Methods Patients (204 cases) with chronic congestive heart failure in Yan'an University Affiliated Hospital from April 2016 to September 2018 were randomly divided into control and treatment groups, and each group had 102 cases. Patients in the control group were po administered with Ivabradine Hydrochloride Tablets, starting dosage 2.5 mg/time, twice daily, and the dose was adjusted according to the change of heart rate, but the maximum dose was not more than 7.5 mg/time, twice daily. Patients in the treatment group were po administered with Recombinant Human Brain Natriuretic Peptide for injection on the basis of the control group, intravenous pulse therapy at a dose of 1.5 g/kg, then maintained the treatment with 0.007 5 μg/(kg·min) for 2 d. Patients in two groups were treated for 1 month. After treatment, the clinical efficacies were evaluated, and cardiac function indexes, the serum levels of inflammatory factors, the serum factors levels in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 69.61% and 85.29%, respectively, and there was difference between two groups (P<0.05). After treatment, the LVEF and CO in two groups were significantly increased, but the LVEDP in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the LVEF and CO in the treatment group were significantly higher than those in the control group, but LVEDP in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of IL-6, CRP, and TNF-α in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the serum levels of inflammatory factors in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of LCN-2, Sgp130, and NT-pro BNP in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the serum factors levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Recombinant Human Brain Natriuretic Peptide for injection combined with Ivabradine Hydrochloride Tablets has clinical curative effect in treatment of chronic congestive heart failure, can improve the heart function, reduce the level of inflammation, and regulate the level of serum factors, with good safety, which has a certain clinical application value.