目的 探讨麝香通心滴丸联合沙库巴曲缬沙坦治疗缺血性心力衰竭的临床疗效。方法 选择2018年4月—2020年10月洛阳市第三人民医院收治的86例缺血性心力衰竭患者，采用随机数字表法分为对照组（43例）和治疗组（43例）。对照组口服沙库巴曲缬沙坦钠片，50 mg/次，2次/d，治疗组在对照组的基础上口服麝香通心滴丸，70 mg/次，3次/d。两组均治疗30 d。观察两组的临床疗效，比较两组治疗前后心功能指标、血清炎性因子和心率变异性指标的变化情况。结果 治疗后，治疗组总有效率为93.02 %，显著高于对照组的72.09%（P<0.05）。治疗后，两组左心室射血分数（LVEF）、短轴缩短率（FS）水平较治疗前升高，但左心室质量指数（LVMI）、平均室壁应力（MWS）水平较治疗前降低（P<0.05）；治疗后，治疗组心功能指标改善优于对照组（P<0.05）。治疗后，两组肿瘤坏死因子-α（TNF-α）、超敏-C反应蛋白（hs-CRP）、脑自然肽N端前体蛋白（NT-Pro BNP）、核转录因子NF-κB（NF-κB）水平与治疗前比较均明显降低（P<0.05）；且治疗组炎症细胞因子水平均显著低于对照组（P<0.05）。治疗后，两组全部窦性心搏NN间期（SDNN）、相邻NN期间差值的均方根（RMSSD）、相邻正常R-R间期差值>50 ms心搏数占分析心搏数总数的百分比（PNN50）、连续5 min正常窦性R-R期间平均值（SDANN）水平均显著升高（P<0.05）；且治疗后，治疗组心率变异性指标水平高于对照组（P<0.05）。结论 麝香通心滴丸联合沙库巴曲缬沙坦治疗缺血性心力衰竭疗效良好，可改明显善患者心功能、炎症细胞因子和心率变异性指标，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Shexiang Tongxin Dropping Pills combined with salkubatrov in treatment of ischemic heart failure. Methods A total of 86 patients with ischemic heart failure admitted to the Third People's Hospital of Luoyang from April 2018 to October 2020 were selected and divided into control group (43 cases) and treatment group (43 cases) by random number table method. Patients in the control group were po administered with Sacubatrovalsartan Sodium Tablets, 50 mg/time, twice daily. Patients in the treatment group were po administered with Shexiang Tongxin Dropping Pills on the basis of the control group, 70 mg/time, three times daily. Patients in two groups were treated for 30 d. After treatment, the clinical efficacy was evaluated, and the changes of cardiac function indexes, serum inflammatory factors and heart rate variability indexes were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 93.02%, which was significantly higher than that of the control group (72.09%, P<0.05). After treatment, left ventricular ejection fraction (LVEF) and short-axis shorting rate (FS) were increased, but left ventricular mass index (LVMI) and mean ventricular wall stress (MWS) were decreased (P<0.05). After treatment, the improvement of heart function indexes in treatment group was better than that in control group (P<0.05). After treatment, the levels of tumor necrosis factor-α (TNF-α), hypersensitive C-reactive protein (hs-CRP), brain natural peptide N-terminal precursor protein (NT-pro BNP), and nuclear transcription factor NF-κB (NF-κB) in two groups were significantly decreased compared with before treatment (P<0.05). The levels of inflammatory cytokines in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, total sinus heart beat NN interval (SDNN), root mean square of difference between adjacent NN periods (RMSSD), percentage of adjacent normal R-R interval difference>50 ms in total heart beats analyzed (PNN50), and mean of normal sinus R-R period for 5 min (SDANN) was significantly increased (P<0.05); After treatment, the heart rate variability of treatment group was higher than that of control group (P<0.05). Conclusion Shexiang Tongxin Dropping Pills combined with salkubatrov has a good curative effect in treatment of ischemic heart failure, and can significantly improve the cardiac function, inflammatory cytokines and heart rate variability indexes of patients, which has a certain clinical application value.

R972

洛阳市科技计划医疗卫生项目（1603002A-5）