目的 探讨卡托普利与左西孟旦联合治疗慢性心力衰竭临床疗效。方法 选取2021年6月-2022年5月中国人民解放军空军军医大学第二附属医院收治的200例慢性心力衰竭患者,随机分为对照组(100例)和治疗组(100例)。对照组患者静脉滴注左西孟旦注射液,6~12 µg/kg,1次/d。治疗组在对照组基础上口服复方卡托普利片,12.5 mg/次,3次/d。两组患者治疗7 d。观察两组患者临床疗效,比较治疗前后两组患者症状好转时间,心功能指标左室射血分数(LVEF)、左心室收缩末容积(LVSED)、左心室舒张末容积(LVEDV)和左心室舒张末期内径(LVEDD),血清因子N-末端B型利钠肽前体(NT-proBNP)、心肌肌钙蛋白(cTnT)、白细胞介素-6(IL-6)和金属蛋白酶-9(MMP-9)水平及不良反应。结果 治疗后,治疗组临床有效率为98.00%,明显高于对照组(88.00%,P<0.05)。治疗后,治疗组患者出现的症状好转时间均短于对照组(P<0.05)。治疗后,两组心功能LVEF明显高于治疗前,而LVSED、LVDEV和LVEDD指标明显降低(P<0.05);且治疗组心功能指标明显好于对照组(P<0.05)。治疗后,两组血清因子IL-6、NT-proBNP、cTnT、MMP-9水平低于治疗前(P<0.05),且治疗组显著低于对照组(P<0.05)。治疗期间,治疗组不良反应发生率为5.00%,明显低于对照组(14.01%,P<0.05)。结论 卡托普利联合左西孟旦治疗慢性心力衰竭疗效显著,明显改善患者症状,有效改善心功能,延缓心肌纤维化的进展,并能降低炎症反应。

Objective To investigate the efficacy of captopril combined with levosimendan in treatment of chronic heart failure. Methods Patients (200 cases) with chronic heart failure in the Second Affiliated Hospital of PLA Air Force Military Medical University from June 2021 to May 2022 were randomly divided into control (100 cases) and treatment (100 cases) group. Patients in the control group were iv administered with Levosimendan Injection, 6-12 µg/kg, once daily. Patients in the treatment group po administered with Compound Captopril Tablets on the basis of the control group, 12.5 mg/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical evaluation was evaluated, the relief time of symptom, the cardiac function indexes LVEF, LVSED, LVDEV and LVEDD，the levels of serum factor IL-6, NT-proBNP, cTnT and MMP-9, and and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 98.00%, which was significantly higher than that of the control group (88.00%, P＜0.05). After treatment, the time of symptom improvement in the treatment group was earlier than that in the control group (P＜0.05). After treatment, the cardiac function LVEF in two groups was significantly higher than that before treatment, while the indexes of LVSED, LVDEV and LVEDD were significantly decreased (P＜0.05), and the cardiac function indexes of the treatment group were significantly better than those of the control group (P＜0.05). After treatment, the serum levels of IL-6, NT-proBNP, cTnT and MMP-9 in two groups were lower than those before treatment (P＜0.05), and which in the treatment group were significantly lower than those in the control group (P＜0.05). During the treatment, the incidence of adverse reactions in the treatment group was 5.00%, which was significantly lower than that in the control group (14.01%, P＜0.05). Conclusion The combination of levosimendan and captopril is more effective, significantly improve patients' symptoms, effectively improve cardiac function, delay the progression of myocardial fibrosis, and reduce inflammatory reaction.

R914

国家自然科学基金资助项目(81900338)