目的 探讨麝香心脑乐片联合硫酸氢氯吡格雷片对急性ST段抬高型心肌梗死患者的临床疗效。方法 选取2019年1月—2020年12月郑州大学第五附属医院收治的98例急性ST段抬高型心肌梗死患者，按随机数字表法分为对照组和治疗组，每组各49例。对照组患者口服硫酸氢氯吡格雷片，300 mg/次，1次/d，连续服用7 d后改为75 mg/次，1次/d。治疗组在对照组基础上口服麝香心脑乐片，3片/次，3次/d。两组均持续治疗24周。观察两组的临床疗效，比较两组的心功能、心肌损伤标志物以及血清血管紧张素Ⅱ（Ang Ⅱ）、内皮素-1（ET-1）、肿瘤坏死因子α（TNF-α）水平。结果 治疗后，治疗组总有效率为91.84%，高于对照组的总有效率73.47%（P<0.05）。治疗后，两组左心室射血分数（LVEF）均高于治疗前，左心室舒张末期容积内径（LVEDD）、左心室收缩末期容积内径（LVESD）均小于治疗前（P<0.05）；且治疗组LVEF高于对照组，LVEDD、LVESD均小于对照组（P<0.05）。治疗后，两组血清心肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）水平均低于治疗前（P<0.05）；且治疗组血清cTnI、CK-MB水平均低于对照组（P<0.05）。治疗后，两组血清Ang Ⅱ、ET-1、TNF-α水平均低于治疗前（P<0.05）；且治疗组血清Ang Ⅱ、ET-1、TNF-α水平均低于对照组（P<0.05）。结论 麝香心脑乐片联合硫酸氢氯吡格雷片治疗急性ST段抬高型心肌梗死临床疗效肯定，能改善心功能，调节血清cTnI、CK-MB、Ang Ⅱ、ET-1、TNF-α水平，且临床应用安全性较好。

Objective To investigate the clinical effect of Shexiang Xinnaole Tablets combined with Clopidogrel Bisulfate Tablets in treatment of acute ST-segment elevation myocardial infarction. Methods Patients (98 cases) with acute ST-segment elevation myocardial infarction in the Fifth Affiliated Hospital of Zhengzhou University from January 2019 to December 2020 were randomly divided into control and treatment groups, and each group had 49 cases. Patients in the control group were po administered with Clopidogrel Bisulfate Tablets, 300 mg/time, once daily, after taking 7 d continuously, and it was changed to 75 mg/times, once daily. Patients in the treatment group were po administered with Shexiang Xinnaole Tablets on the basis of the control group, 3 tablets/time, three times daily. Patients in two groups were treated for 24 weeks. After treatment, the clinical efficacies were evaluated, and cardiac function, myocardial injury markers, the levels of Ang Ⅱ, ET-1, and TNF-α in two groups were compared. Results After treatment, the total effective rate in the treatment group was 91.84%, which was higher than 73.47% in the control group (P<0.05). After treatment, the LVEF in two groups was higher than that before treatment, but the LVEDD and LVESD in two groups were lower than those before treatment (P<0.05). The LVEF in the treatment group was higher than that in the control group, but the LVEDD and LVESD in the treatment were lower than those in the control group (P<0.05). After treatment, the serum levels of cTnT and CK-MB in two groups were lower than those before treatment (P<0.05). The serum levels of cTnI and CK-MB in the treatment group were lower than those in the control group (P<0.05). After treatment, the serum levels of Ang Ⅱ, ET-1, and TNF-α in two groups were lower than those before treatment (P<0.05). The serum levels of Ang Ⅱ, ET-1, and TNF-α in the treatment group were lower than those in the control group (P<0.05). Conclusion Shexiang Xinnaole Tablets combined with Clopidogrel Bisulfate Tablets has a positive clinical effect in treatment of acute ST-segment elevation myocardial infarction, which can improve heart function, and regulate the serum levels of cTnI, CK-MB, Ang Ⅱ, ET-1, and TNF-α, with good safety.

R972

河南省科技攻关计划项目（172102310265）