目的 探讨黄芪注射液与沙库巴曲缬沙坦协同治疗老年慢性心力衰竭的临床效果。方法 选取2021年1月—2025年1月武汉市梨园医院收治的90例老年慢性心力衰竭患者，按随机数字法分为对照组45例和治疗组45例。对照组口服沙库巴曲缬沙坦钠片，起始剂量每次50 mg，每日2次，每周增加50 mg，直至最大剂量每次200 mg。治疗组患者在对照组的基础上给予iv黄芪注射液，将本品40 mL加入0.9%氯化钠250 mL稀释后静脉滴注，1次/d。两组用药14 d。观察两组的临床疗效，比较两组改良早期预警评分量表（MEWS）评分、中医症状积分、明尼苏达心力衰竭生活质量评分表（MLHFQ）评分、6 min步行距离、心功能相关指标和血清炎性因子水平的变化。结果 治疗后，治疗组总有效率是95.56%，显著高于对照组的77.78%（P＜0.05）。治疗后，两组患者心悸评分、胸痛评分、气短乏力评分、下肢水肿评分均较同组治疗前显著降低（P＜0.05）；治疗后，与对照组对比，治疗组心悸评分、胸痛评分、气短乏力评分、下肢水肿评分均更低（P＜0.05）。治疗后，两组MEWS评分、MLHFQ评分均降低，6 min步行距离显著增加（P＜0.05）；治疗后，与对照组对比，治疗组MEWS评分、MLHFQ评分均更低，且6 min步行距离增加（P＜0.05）。治疗后，两组左心室收缩期末内径（LVESD）、左心室舒张期末内径（LVEDD）指标均较前显著降低，左心室射血分数（LVEF）升高（P＜0.05）；与对照组对比，治疗组LVEDD、LVESD均更低，LVEF指标更高（P＜0.05）。治疗后，两组患者血清可溶性生长刺激表达基因2蛋白（sST2）、N末端脑钠肽前体（NT-proBNP）、缺氧诱导因子1α（HIF-1α）、血清视黄醇结合蛋白4（RBP4）水平均显著降低（P＜0.05）；与对照组对比，治疗组sST2、NT-proBNP、HIF-1α、RBP4水平均更低（P＜0.05）。结论 黄芪注射液与沙库巴曲缬沙坦协同治疗老年慢性心力衰竭有显著疗效，可有效增强患者的心功能，能降低机体的炎症反应状态，患者生活质量明显提升，且药物安全，值得借鉴与推广。

Objective To investigate the clinical efficacy of Huangqi Injection combined with sacubitril valsartan in treatment of senile coronary heart disease with heart failure. Methods A total of 90 elderly patients with chronic heart failure who were admitted to Liyuan Hospital of Wuhan from January 2021 to January 2025 were selected and divided into control group of 45 cases and treatment group of 45 cases according to random number method. Patients in control group were given oral Sacubitril Valsartan Sodium Tablets, with an initial dose of 50 mg each time, twice daily, and the dose was increased by 50 mg weekly until the maximum dose of 200 mg. Patients in treatment group were given intravenous injection of Huangqi Injection in addition to the control group, 40 mL was added to 250 mL of 0.9% sodium chloride for dilution and then administered intravenously once daily. Both groups were treated for 14 d. The clinical efficacy of two groups was observed, and the changes in modified early warning score scale (MEWS) score, traditional Chinese medicine symptom score, Minnesota Heart Failure Quality of Life Scale (MLHFQ) score, 6 min walking distance, cardiac function-related indicators, and serum inflammatory factor levels were compared between two groups. Results After treatment, the total effective rate of treatment group was 95.56%, significantly higher than that of control group (77.78%) (P < 0.05). After treatment, the heart palpitation score, chest pain score, shortness of breath and fatigue score, and lower extremity edema score of both groups were significantly lower than those before treatment in the same group (P < 0.05). After treatment, compared with control group, the heart palpitation score, chest pain score, shortness of breath and fatigue score, and lower extremity edema score of the treatment group were all lower (P < 0.05). After treatment, the MEWS score and MLHFQ score of both groups decreased, and the 6 min walking distance significantly increased (P < 0.05). After treatment, compared with control group, the MEWS score and MLHFQ score of treatment group were both lower, and the 6 min walking distance increased (P < 0.05). After treatment, the left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) indicators of both groups were significantly lower than before, and the left ventricular ejection fraction (LVEF) increased (P < 0.05). Compared with control group, the LVEDD and LVESD of treatment group were lower, and the LVEF indicator was higher (P < 0.05). After treatment, the serum soluble growth stimulation expressed gene 2 protein (sST2), N-terminal brain natriuretic peptide precursor (NT-proBNP), hypoxia-inducible factor 1α (HIF-1α), and serum retinol binding protein 4 (RBP4) levels of both groups were significantly lower (P < 0.05). Compared with control group, the sST2, NT-proBNP, HIF-1α, and RBP4 levels of treatment group were all lower (P < 0.05). Conclusion The combined treatment of Huangqi Injection and sacubitril valsartan for elderly patients with chronic heart failure has remarkable therapeutic effect. It can effectively enhance the patient's cardiac function, reduce the inflammatory response state of the body, significantly improve the quality of life, and the drugs are safe. This treatment method is worthy of reference and promotion.

R972

湖北省卫生健康委员会中医药科研项目（ZY2021M047）