目的 探讨麝香通心滴丸联合盐酸伊伐布雷定片治疗老年稳定型心绞痛的临床疗效。方法 选择2020年3月—2021年3月在郑州市第九人民医院治疗的104例稳定型心绞痛老年患者，根据用药的差别分为对照组和治疗组，每组各52例。对照组口服盐酸伊伐布雷定片，5 mg/次，2次/d；治疗2周后，若静息心率持续＞60次/min，7.5 mg/次，2次/d；若静息心率持续＜50次/min，每次2.5 mg，2次/d；若心率在50~60次/min，维持每次5 mg，2次/d。治疗组在对照组基础上口服麝香通心滴丸，2丸/次，3次/d。两组患者均治疗8周。观察两组患者临床和心电图疗效，比较治疗前后两组患者血管内皮功能，SAQ、GSES和Duke评分及左室射血分数（LVEF）水平。结果 经治疗，对照组和治疗组疗效总有效率分别为82.69%、98.08%（P＜0.05）。经治疗，对照组和治疗组在心电图疗效总有效率分别为84.62%、98.08%（P＜0.05）。治疗后，两组内皮素-1（ET-1）和血管性血友病因子（vWF）水平明显降低，而血管内皮生长因子（VEGF）和一氧化氮（NO）水平明显升高（P＜0.05），且治疗组血管内皮功能明显好于对照组（P＜0.05）。治疗后，两组患者SAQ、GSES和Duke评分均显著上升，LVEF水平明显升高（P＜0.05），且治疗组患者量表积分和LVEF明显高于对照组（P＜0.05）。结论 麝香通心滴丸联合盐酸伊伐布雷定片治疗老年稳定型心绞痛可有效改善患者血管内皮功能，改善心肌缺血程度，提高左室射血分数。

Objective To investigate the effect of Shexiang Tongxin Dropping Pills combined with ivabradine hydrochloride in treatment of elderly stable angina pectoris.Methods Patients (104 cases) with stable angina pectoris in Ninth People's Hospital of Zhengzhou from March 2020 to March 2021 were divided into control and treatment group based on different treatments, and each group had 52 cases. Patients in the control group were po administered with Ivabradine Hydrochloride Tablets, 5 mg/time, twice daily, if resting heart rate continues more than 60 times/min after 2 weeks, 7.5 mg/time, twice daily, if resting heart rate continues less than 50 times/min, 2.5 mg/time, twice daily, if the heart rate was 50 — 60 times/min, maintain 5 mg/time, twice daily. Patients in the treatment group were po administered with Shexiang Tongxin Dropping Pills on the basis of the control group, 2 pills/time, three times daily. Patients in two groups were treated for 8 weeks. After treatment, the clinical and ECG evaluation were evaluated, the endothelial function, the scores of SAQ, GSES, and Duke and the levels of LVEF in two groups before and after treatment were compared.Results After treatment, the clinical effective rates of the control group and the treatment group were 82.69% and 98.08%, respectively (P < 0.05). After treatment, the ECG effective rates of the control group and the treatment group were 84.62% and 98.08%, respectively (P < 0.05). After treatment, the levels of serum ET-1 and vWF were significantly decreased, while the levels of VEGF and NO were significantly increased in two groups (P < 0.05), and the vascular endothelial function in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the scores of SAQ, GSES, and Duke and the level of LVEF in two groups were significantly increased, and the scores and LVEF in the treatment group were significantly higher than those in the control group (P < 0.05).Conclusion Shexiang Tongxin Dropping Pills combined with ivabradine in treatment of elderly stable angina pectoris can effectively improve the vascular endothelial function, improve the degree of myocardial ischemia and increase the left ventricular ejection fraction.

R972

河南省医学科技攻关计划项目（201702333）