目的 探讨伊伐布雷定联合左西孟旦治疗慢性心力衰竭的临床疗效。方法 选取2017年1月—2018年1月在焦作市第二人民医院进行治疗的80例慢性心力衰竭患者，根据用药差别分为对照组和治疗组，每组各40例。对照组患者给予左西孟旦注射液，先以12 μg/kg初始剂量静脉推注，推注10 min，然后以微量泵持续泵入，泵入速度0.1 μg/(kg·min)，持续泵入24 h。治疗组在对照组基础上口服盐酸伊伐布雷定片，5 mg/次，2次/d。两组均治疗2周后进行效果比较。观察两组的临床疗效，比较两组治疗前后心功能指标、6 min步行距离（6WMT）、GQOLI-74评分、血清学指标和心肌纤维化标志物的变化情况。结果 治疗后，对照组和治疗组的总有效率分别是75.0%、95.0%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组左心室射血分数（LVEE）、6WMT、GQOLI-74评分均较治疗前显著升高，而左心室收缩末内径（LVEDD）、左心室收缩末容量（LVESV）、左心室舒张末内径（LVESD）均显著下降，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，治疗组LVEE、6WMT、GQOLI-74评分高于对照组，而LVEDD、LVESV、LVESD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N-末端B型利钠肽前体（NT-proBNP）、可溶性晚期糖基化终产物受体（sRAGE）、心肌肌钙蛋白T（cTnT）、高迁移率族蛋白B1（HMGB1）、金属蛋白酶9（MMP-9）、β-内啡肽（β-EP）、Ⅰ型胶原交联羧基末端肽（ICTP）、Ⅲ型前胶原氨基末端肽（PⅢNP）、结缔组织生长因子（CTGF）、透明质酸（HA）、层连蛋白（LA）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）；治疗后，治疗组这些血清学指标和心肌纤维化标志物指标均显著低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 伊伐布雷定联合左西孟旦治疗慢性心力衰竭具有较好的临床疗效，可有效改善患者心功能，降低血清细胞因子水平，延缓心肌纤维化进展，促进患者运动耐量提高，有利于改善患者生活质量，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of ivabradine combined with levosimendan in treatment of chronic heart failure. Methods Patients (80 cases) with chronic heart failure in Jiaozuo Second People's Hospital from January 2017 to January 2018 were divided into control (40 cases) and treatment (40 cases) groups according to different medication regimens. Patients in the control group were given Levosimendan Injection, and the initial dosage of 12 μg/kg was injected intravenously for 10 min, and then the pump was continuously pumped at the rate of 0.1 μg/(kg·min) by micropump for 24 h. Patients in the treatment group were po administered with Ivabradine Hydrochloride Tablets, 5 mg/time, twice daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the changes of cardiac function indicators, 6WMT, GQOLI-74 score, serological indicators and myocardial fibrosis markers in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 75.0% and 95.0%, respectively, and there were differences between two groups (P<0.05). After treatment, LVEE, 6WMT, and GQOLI-74 in two groups were significantly increased, but LVEDD, LVESV, and LVESD were significantly decreased, and there were differences in the same group (P<0.05). After treatment, the LVEE, 6WMT, and GQOLI-74 in the treatment group were higher than those in the control group, but LVEDD, LVESV, and LVESD were lower than those in the control group, and there were differences between two groups (P<0.05). After treatment, NT-proBNP, sRAGE, cTnT, HMGB1, MMP-9, β-EP, ICTP, PⅢNP, CTGF, HA, and LA in two groups were significantly decreased, and there were differences in the same group (P<0.05). After treatment, those serological indexes and myocardial fibrosis markers in the treatment group were significantly lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Ivabradine combined with levosimendan has significant effect in treatment of chronic heart failure, and can effectively improve the cardiac function, and reduce the level of serum cytokines, delay the progress of myocardial fibrosis, promote the exercise tolerance, and improve the life quality, which has a certain clinical application value.