目的 探讨沙库巴曲缬沙坦钠联合硝酸甘油治疗老年慢性心力衰竭的临床疗效。方法 选择2021年2月—2022年2月在阜外华中心血管病医院接受治疗的94例老年慢性心力衰竭患者，根据入院顺序分为对照组（47例）和治疗组（47例）。对照组静脉泵入硝酸甘油注射液，每次10 mg加入生理盐水50mL，5～8mL/h速度持续静脉泵入，1次/d；治疗组在对照组基础上口服沙库巴曲缬沙坦钠片，100mg/次，2次/d。两组患者均治疗2周。观察两组患者临床疗效，比较治疗前后两组患者临床症状改善时间，MLHFQ评分、Lee氏心衰积分和SCHFI评分，血清正五聚体蛋白-3（PTX-3）、可溶性肿瘤发生抑制蛋白2（sST2）、N末端B型钠尿肽原（NT-proBNP）、可溶性尿激酶型纤溶酶原激活物受体（suPAR）和中心脏型肌球蛋白结合蛋白-C（cMyBP-C）水平及心功能指标左心室射血分数（LVEF）、心脏指数（CI）、左室质量指数（LVMI）、心排血量（CO）和室间隔厚度（IVSd）。结果 治疗后，对照组患者总有效率为80.85%，明显低于治疗组（97.87%，P<0.05）。经治疗，治疗组临床症状改善时间均明显早于对照组（P<0.05）。治疗后，两组MLHFQ评分和Lee氏心衰积分明显降低，而SCHFI评分明显升高（P<0.05），且治疗组评分明显好于对照组（P<0.05）。治疗后，两组血清PTX-3、sST2、NT-proBNP、suPAR、cMyBP-C水平明显降低（P<0.05），且治疗组明显低于对照组（P<0.05）。治疗后，两组LVEF、CI和CO水平明显升高，而LVMI、IVSd水平明显降低（P<0.05），且治疗组心功能明显好于对照组（P<0.05）。结论 沙库巴曲缬沙坦钠联合硝酸甘油治疗老年慢性心力衰竭临床效果显著，可有效改善患者症状，提高患者心功能，抑制心室重构，不仅可改善生活质量，还促进改善自我护理能力。

Objective To investigate the clinical efficacy of sacubitril valsartan sodium combined with nitroglycerin in treatment of senile chronic heart failure. Methods Patients (94 cases) with chronic heart failure in Fuwai Central China Cardiovascular Hospital from February 2021 to February 2022 were divided into control (47 cases) and treatment (47 cases) group based on hospitalized order. Patients in the control group were iv administered with Nitroglycerin Injection, 10 mg added into normal saline 50 mL, continuous intravenous pumping at the speed of 5 — 8 mL/h, once daily. Patients in the treatment group were po administered with Sacubitril Valsartan Sodium Tablets on the basis of the control group, 100 mg/time, twice daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical evaluation was evaluated, the improvement time of clinical symptoms, the scores of MLHFQ, Lee’s heart failure and SCHFI, the levels of serum PTX-3, sST2, NT-proBNP, suPAR, and cMyBP-C, the levels of cardiac function indexes LVEF, CI, CO, LVMI, and IVSd in two groups before and after treatment were compared. Results After treatment, the total clinical effective rate of the control group was 80.85%, which was significantly lower than that of the treatment group (97.87%, P < 0.05). After treatment, the improvement time of clinical symptoms in the treatment group was significantly earlier than that in the control group (P< 0.05). After treatment, the MLHFQ score and Lee's heart failure score were significantly decreased, while the SCHFI score was significantly increased in two groups (P < 0.05), and these scores in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the serum levels of PTX-3, sST2, NT-proBNP, suPAR, and cMyBP-C in two groups were significantly decreased (P < 0.05), which in the treatment group were significantly lower than those in the control group (P< 0.05). After treatment, the levels of LVEF, CI, and CO in two groups were significantly increased, while the levels of LVMI and IVSd were significantly decreased (P < 0.05), and the cardiac function in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion The clinical effect of Sacubitril Valsartan Sodium Tablets combined with Nitroglycerin Injection in the treatment of senile chronic heart failure is remarkable. It can effectively improve patients' symptoms, improve cardiac function, inhibit ventricular remodeling, not only improve the quality of life, but also promote the improvement of self-care ability, and which is worthy of clinical application.

R972

河南省医学科技攻关计划（联合共建）项目（LHGJ20190812）