目的 探讨伊伐布雷定联合米力农治疗慢性心力衰竭的临床疗效。方法 选取2020年1月—2022年1月中国人民解放军联勤保障部队第九八一医院治疗的118例心力衰竭患者，按照随机数字表法将患者分为对照组和治疗组，每组各59例。对照组患者静脉滴注米力农注射液，10 mg加入生理盐水50 mL，微量泵以0.375～0.750µg/(kg∙min)维持，1次/d。治疗组患者在对照组的基础上口服盐酸伊伐布雷定片，5 mg/次，2次/d。两组连续用药7 d。观察两组的治疗效果和临床症状改善时间，比较两组患者治疗前后左室收缩期内径（LVESV）、左室射血分数（LVEF）、左室舒张末期内径（LVEDV）、血清可溶性生长刺激表达基因2蛋白（sST2）、白细胞介素-6（IL-6）、氨基末端B型钠尿肽（NT-proBNP）、肿瘤坏死因子-α（TNF-α）水平的变化情况。比较两组不良反应情况。结果 治疗后，治疗组患者总有效率是98.31%，显著高于对照组的83.05%（P＜0.05）。治疗后，治疗组心慌、胸闷、气短、下肢水肿等症状缓解时间均短于对照组（P＜0.05）。治疗后，两组LVEF均较治疗前显著升高，而LVESV、LVEDV显著降低（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sST2、IL-6、NT-proBNP、TNF-α水平均较治疗前显著降低（P＜0.05）；治疗后，治疗组血清学指标低于对照组（P＜0.05）。治疗组不良反应发生率是6.78%，显著低于对照组的15.25%（P＜0.05）。结论 伊伐布雷定联合米力农注射液治疗慢性心力衰竭效果确切，能明显缓解患者临床症状，有效改善心功能状态，并可降低炎性反应，值得临床推广应用。

Objective To investigate the therapeutic effect of ivabradine combined with milrinone in treatment of chronic heart failure. Methods A total of 118 patients with heart failure treated in 981 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from January 2020 to January 2022 were selected and divided into control group and treatment group according to random number table method, with 59 cases in each group. Patients in the were iv administered with Milrinone Injection, 10 mg was added into 50 mL 0.9% normal saline, and the micropump was maintained at 0.375-0.75 µg/(kg·min), once daily. Patients in the treatment group were po administered with Ivabradine Hydrochloride Tablets on the basis of the control group, 5 mg/time, twice daily. Patients in two groups were treated for 7 d. After treatment, the treatment effect and improvement time of clinical symptoms of the two groups were observed. After treatment, left ventricular systolic diameter (LVESV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDV), serum soluble growth stimulation expression gene 2 protein (sST2), interleukin 6 (IL-6), amino-terminal B-type natriuretic peptide (NT-probNP), and tumor necrosis factor α (TNF-α) were compared between the two groups before and after treatment. The adverse reactions of two groups were compared. Results After treatment, the total effective rate in the treatment group was 98.31%, significantly higher than that in the control group (83.05%, P < 0.05). After treatment, the relief time of palpitation, chest tightness, shortness of breath, and lower limb edema in the treatment group was shorter than that in the control group (P < 0.05). After treatment, LVEF in both groups was significantly increased compared with before treatment, while LVESV and LVEDV were significantly decreased (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 sST2, IL-6, NT-probNP and TNF-α in two groups were significantly decreased compared with before treatment (P < 0.05). After treatment, the serum index of the treatment group was lower than that of the control group (P < 0.05). The incidence of adverse reactions in treatment group was 6.78%, significantly lower than 15.25% in control group (P < 0.05).Conclusions Ivabradine combined with milrinone has exact effect in treatment of chronic heart failure, and can significantly relieve the clinical symptoms of patients, effectively improve the cardiac function, and reduce the inflammatory response, which is worthy of clinical application.

R972

承德市科技支撑项目(201904A061)