目的 探讨单硝酸异山梨酯联合培哚普利叔丁胺治疗慢性心力衰竭的临床疗效。方法 选取2019年6月—2021年6月在驻马店市中心医院就诊治疗的108例慢性心力衰竭患者，按照随机数字表法将患者分为对照组和治疗组，每组54例。对照组患者早晨饭前口服培哚普利叔丁胺片，4 mg/次，1次/d。治疗组患者在对照组的治疗基础上口服单硝酸异山梨酯片，1片/次，2次/d。两组患者连续服用药物7 d。观察两组的临床疗效，比较两组临床症状缓解时间、心功能指标和血清炎性因子水平。结果 治疗后，治疗组患者总有效率是98.15%，显著高于对照组的81.48%（P＜0.05）。治疗组患者胸闷、乏力、胸痛、气短等症状缓解时间均显著短于对照组（P＜0.05）。治疗后，两组患者左室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）均较治疗前显著降低，但左室射血分数（LVEF）显著升高（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，两组患者血清白细胞介素6（IL-6）、氨基末端脑钠肽前体（NT-proBNP）、肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）水平均较治疗前显著降低（P＜0.05）；治疗后，治疗组患者血清炎性因子水平显著低于对照组（P＜0.05）。结论 单硝酸异山梨酯联合培哚普利叔丁胺治疗慢性心力衰竭患者效果较好，能有效改善心功能状态，降低心肌组织的炎症反应，值得临床推广应用。

Objective To investigate the efficacy of isosorbide mononitrate combined with perindopril tert-butylamine in treatment of chronic heart failure.Methods A total of 108 patients with chronic heart failure treated in Zhumadian Central Hospital from June 2019 to June 2021 were selected and divided into control group and treatment group according to random number method, with 54 patients in each group. Patients in the control group were po administered with Perindopril tert-Butylamine Tablets before meals in the morning, 4 mg/time, once daily. Patients in the treatment group were po administered with Isosorbide Mononitrate Tablets on the basis of the control group, 1 tablet/time, twice daily. Patients in both groups continued to take drugs for 7 d. The clinical efficacy of the two groups were observed, and the clinical symptom relief time, cardiac function indexes and serum inflammatory factor levels were compared between the two groups.Results After treatment, the total effective rate in treatment group was 98.15%, significantly higher than that in control group (81.48%) (P < 0.05). The relief time of chest tightness, fatigue, chest pain, shortness of breath and other symptoms in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) in two groups were significantly decreased compared with before treatment, but left ventricular ejection fraction (LVEF) was significantly increased (P < 0.05). After treatment, the improvement of cardiac function index in the treatment group was better than that in the control group (P < 0.05). After treatment, the levels of serum IL-6, NT-proBNP, TNF-α, and CRP in two groups were significantly decreased (P < 0.05). After treatment, the level of serum inflammatory factors in treatment group was significantly lower than that in control group (P < 0.05).Conclusion Isosorbide mononitrate combined with Perindopril tert-Butylamine Tablets has good curative effect in treatment of chronic heart failure, and can effectively improve the state of cardiac function and reduce the inflammatory response of myocardial tissue, which is worthy of clinical application.

R972

河北省医学科学研究项目[冀工办科教(2017)3号]