目的 探讨复方丹参滴丸联合托伐普坦治疗急性心肌梗死并发心力衰竭的临床效果。方法 选取2018年3月-2019年8月新乡医学院第一附属医院收治的94例急性心肌梗死并发心力衰竭患者，随机分成对照组（47例）和治疗组（47例）。对照组口服托伐普坦片，15 mg/次，1次/d。治疗组在对照组基础上口服复方丹参滴丸，0.27 g/次，3次/d。两组均治疗7 d。观察两组患者临床疗效，比较治疗前后两组患者24 h尿量、临床表现缓解时间，心脏标志物心肌肌钙蛋白I（cTnI）、肌红蛋白（Myo）、心脏脂肪酸结合蛋白（H-FABP）、B型利钠肽（BNP）和半乳糖凝集素-3（Gal-3）水平及超声心动图参数。结果 治疗后，对照组和治疗组临床有效率分别为78.7%、93.6%，两组比较差异有统计学意义（P<0.05）。治疗后，治疗组24 h尿量显著增加（P<0.05），且治疗组相关临床表现缓解时间则均比对照组显著缩短（P<0.05）。治疗后，两组患者血清cTnI、Myo、H-FABP、BNP和Gal-3水平显著低于治疗前（P<0.05），且治疗组患者比对照组下降更为显著（P<0.05）。治疗后，两组患者左室射血分数（LVEF）、心排量（CO）均显著高于治疗前（P<0.05），而左心房容积指数（LAVI）、二尖瓣口舒张早期血流速度峰值与二尖瓣环舒张早期组织运动速度峰值比值（E/e'）均显著降低（P<0.05），且治疗组这些超声心动图参数显著优于对照组（P<0.05）。结论 复方丹参滴丸联合托伐普坦能有效缩短急性心肌梗死并发心力衰竭患者临床症状的持续时间，减轻心脏损伤，并有助于促进病人心脏结构及功能的恢复，疗效确切，安全可靠。

Objective To investigate the clinical effect of Compound Danshen Dropping Pills combined with tolvaptan in treatment of acute myocardial infarction complicated with heart failure. Methods Patients (94 cases) with acute myocardial infarction complicated with heart failure in the First Affiliated Hospital of Xinxiang Medical University from March 2018 to August 2019 were randomly divided into control (47 cases) and treatment (47 cases) groups. Patients in the control group were po administered with Tolvaptan Tablets, 15 mg/time, once daily. Patients in the treatment group were po administered with Compound Danshen Dropping Pills on the basis of the control group, 0.27 g/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the 24 h urine volume, clinical manifestation time, cardiac markers cTnI, Myo, H-FABP, BNP, and Gal-3 levels, and the echocardiographic parameters in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 78.7% and 93.6%, respectively, and there were differences between two groups (P < 0.05). After treatment, the 24 h urine volume in treatment group was significantly increased (P < 0.05), and the clinical manifestation time in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, the cardiac markers serum concentration of cTnI, Myo, H-FABP, BNP, and Gal-3 in two groups was significantly decreased (P < 0.05), and which in the treatment group was significantly lower than those in the control group (P < 0.05). After treatment, the LVEF and CO levels in two groups were significantly increased (P < 0.05), but LAVI and E/e' were significantly decreased (P < 0.05), and the echocardiographic parameters in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Compound Danshen Dropping Pills combined with Tolvaptan Tablets can effectively shorten the duration of clinical symptoms of acute myocardial infarction complicated with heart failure, reduce heart damage, and promote the recovery of cardiac structure and function, and the clinical effect is exact and safe.

R972

河南省卫生和计划生育委员会科研课题（201605A3049）