目的 探讨心宝丸联合沙库巴曲缬沙坦治疗慢性心力衰竭的临床疗效。方法 选取2020年7月-2021年7月榆林市第一医院收治的64例慢性心力衰竭患者,按照随机数字表法分为对照组和治疗组,每组各32例。对照组口服沙库巴曲缬沙坦钠片,50 mg/次、2次/d为初始剂量,连服2周后增至100 mg/次、2次/d并维持。治疗组在对照组基础上口服心宝丸,NYHA心功能分级Ⅱ级者4丸/次,3次/d;NYHA心功能分级Ⅲ级者6丸/次,3次/d。两组疗程均为8周。观察两组的临床疗效,比较两组36项健康调查简表(SF-36)总分,6分钟步行距离(6MWD),超声心动图指标[左室射血分数(LVEF)、二尖瓣口血流图舒张早期和舒张晚期血流峰值之比(E/A)、左室心肌做功指数(Tei指数)、左心房前后径(LAD)],外周血中性粒细胞与淋巴细胞比值(NLR)以及血清C反应蛋白(CRP)、同型半胱氨酸(Hcy)、B型利钠肽(BNP)、醛固酮(ALD)水平。结果 治疗后,治疗组总有效率是93.75%,显著高于对照组的75.00%(P<0.05)。治疗后,两组SF-36总分均显著增加,6MWD均显著延长(P<0.05),且以治疗组改善更显著(P<0.05)。治疗后,两组LVEF、E/A均显著增加,左室Tei指数、LAD均显著降低(P<0.05);以治疗组改善更显著(P<0.05)。治疗后,两组外周血NLR和血清CRP、Hcy、BNP、ALD水平均显著下降(P<0.05);且治疗后,治疗组外周血NLR和血清CRP、Hcy、BNP、ALD水平均显著低于对照组(P<0.05)。结论 心宝丸联合沙库巴曲缬沙坦能有效提高慢性心力衰竭患者的整体疗效,减轻机体炎症反应和心肌损害,利于改善患者心功能与运动耐力,提高生活质量,且安全性好。

Objective To investigate the clinical efficacy of Xinbao Pills combined with sacubitril valsartan in treatment of chronic heart failure. Methods Sixty-four patients with chronic heart failure admitted to the First Hospital of Yulin from July 2020 to July 2021 were selected and divided into control group and treatment group according to random number table method, with 32 cases in each group. Patients in the control group were po administered with Sacubitril Valsartan Sodium Tablets. The initial dose was 50 mg/time, twice daily, which was increased to 100 mg/time and twice daily after 2 weeks and maintained. Patients in the treatment group were po administered with Xinbao Pills on the basis of the control group. NYHA cardiac function grade Ⅱ patients took 4 pills/time, 3 times daily, and NYHA cardiac function grade Ⅲ patients took 6 pills/time, 3 times daily. The treatment course of both groups was 8 weeks. After treatment, the clinical efficacy was evaluated, 36 health survey (SF-36) score, 6 minutes walking distance (6 MWDS), echocardiography index [left ventricular ejection fraction (LVEF), mitral valve orifice flow diagram diastolic peak ratio of early and late diastolic blood flow (E/A), left ventricular cardiac work index (Tei index), before and after the left atrium diameter (LAD)], peripheral blood neutrophil to lymphocyte ratio (NLR), serum C-reactive protein (CRP), homocysteine (Hcy), B-type natriuretic peptide (BNP), aldosterone (ALD) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 93.75%, which was significantly higher than that of the control group (75.00%, P＜0.05). After treatment, the total score of SF-36 and 6MWD were significantly increased in both groups (P＜0.05), and the improvement was more significant in the treatment group (P＜0.05). After treatment, LVEF and E/A were significantly increased, while left ventricular Tei index and LAD were significantly decreased in both groups (P＜0.05). The improvement was more significant in the treatment group (P＜0.05). After treatment, the levels of peripheral blood NLR and serum CRP, Hcy, BNP, and ALD in both groups were significantly decreased (P＜0.05). After treatment, the levels of peripheral blood NLR and serum CRP, Hcy, BNP and ALD in the treatment group were significantly lower than those in the control group (P＜0.05). Conclusion Xinbao Pills combined with sacubitril valsartan can effectively improve the overall efficacy of patients with chronic heart failure, can reduce inflammation and myocardial damage, improve patients’ heart function and exercise endurance, improve quality of life, which has good safety.

R914

榆林市2022年度科学技术研究与开发项目(YF-2022-33)