目的 探讨慢性心力衰竭应用麝香保心丸联合缬沙坦治疗的临床效果。方法 选取2017年3月-2019年5月保定市第二中心医院收治的198例慢性心力衰竭患者，随机分成对照组（n=99）和治疗组（n=99）。对照组患者口服缬沙坦胶囊，80 mg/次，1次/d。治疗组在对照组基础上口服麝香保心丸，2丸/次，3次/d。两组均连续治疗4周。比较两组临床疗效；治疗前后对两组患者行常规经胸超声心动图检查[主要观察左心室舒张末期、收缩末期容积（LVEDV和LVESV）及左心室射血分数（LVEF）变化]，测量6 min步行距离（6MWD），行无创血流动力学监测[主要观察肺动脉楔压（PCWP）、总外周阻力（TPR）、心收缩力指数（HI）、心输出量（CO）、心脏指数（CI）变化]，分别采用免疫荧光法和硝酸还原酶法检测血浆B型利钠肽（BNP）、一氧化氮（NO）浓度，采取放射免疫法测定血浆血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）、内皮素-1（ET-1）水平。结果 治疗组总有效率94.9%较对照组85.9%显著提高（P<0.05）。两组治疗后LVEDV、LVESV较治疗前均显著缩小，LVEF、6MWD则均显著升高（P<0.05）；但治疗组以上参数（LVEDV、LVESV、LVEF、6MWD）的改善效果均更为突出（P<0.05）。与治疗前对比，两组治疗后PCWP、TPR均显著降低（P<0.05），而HI、CO、CI均显著增高（P<0.05）；且治疗后，治疗组无创血流动力学参数（PCWP、TPR、HI、CO、CI）的改善效果均显著优于对照组同期（P<0.05）。两组治疗后血浆BNP、AngⅡ、ALD、ET-1、NO水平均显著低于治疗前（P<0.05），且治疗组下降更显著（P<0.05）。结论 麝香保心丸联合缬沙坦治疗慢性心力衰竭的整体疗效显著，能有效改善患者的心脏结构和功能，纠正机体血流动力学异常，抑制RAAS活性，正性调控血管内皮功能，提高运动耐力，具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Shexiang Baoxin Pills combined with valsartan in treatment of chronic heart failure. Methods 198 Patients with chronic heart failure admitted to Baoding Second Central Hospital from March 2017 to May 2019 were randomly divided into control group (n=99) and treatment group (n=99). Patients in the control group were po administered with Valsartan Capsules, 80 mg/time, once daily. Patients in the treatment group were po administered with Valsartan Capsules, 2 pills/time, three times daily. All subjects were treated for 4 weeks. The clinical effects of the two groups were compared. Before and after treatment, two groups of subjects were examined by conventional transthoracic echocardiography[mainly observing the changes of left ventricular end diastole, end systole volume (LVEDV and LVESV) and left ventricular ejection fraction (LVEF)], and 6 min walking distance (6MWD) was measured. Noninvasive hemodynamic monitoring was performed[mainly to observe changes in pulmonary wedge pressure (PCWP), total peripheral resistance (TPR), cardiac contractility index (HI), cardiac output (CO), cardiac index (CI)]. Plasma concentrations of B-type natriuretic peptide (BNP) and nitric oxide (NO) were detected by immunofluorescence and nitrate reductase methods respectively, and plasma levels of angiotensin II (Ang II), aldosterone (ALD), endothelin -1(ET-1) were determined by radioimmunoassay. Results The total effective rate of the treatment group 94.9% was significantly higher than that of the control group 85.9% (P<0.05). After treatment, LVEDV and LVESV decreased significantly, 6MWD and LVEF increased significantly (P<0.05) in both groups. However, the improvement effect of the above parameters (LVEDV, LVESV, LVEF, 6MWD) in the treatment group is more prominent (P<0.05). Compared with before treatment, PCWP and TPR of the two groups decreased significantly after treatment, but HI, CO and CI increased significantly (P<0.05). After treatment, the improvement effect of non-invasive hemodynamic parameters (PCWP, TPR, HI, CO, and CI) in the treatment group was significantly better than those in the control group at the same time (P<0.05). The levels of plasma BNP, AngⅡ, ALD, ET-1 and NO in the two groups after treatment were significantly lower than those before treatment (P<0.05), and the decrease in the treatment group was more significant (P<0.05). Conclusion Shexiang Baoxin Pills combined with valsartan has definite overall curative effect in treatment of chronic heart failure, and can obviously promote the improvement of the patient's cardiac structure and function, correct the abnormal body hemodynamics, inhibit the activity of renin-angiotensin-aldosterone system (RAAS), protect vascular endothelial function, enhance exercise endurance, which has a certain clinical application value.

R972