目的 研究心速宁胶囊联合阿替洛尔治疗老年冠心病室性早搏的临床疗效。方法 选取2023年5月—2024年10月南京市中心医院收治的老年冠心病室性早搏患者120例，以随机数字表法分为对照组和治疗组，每组各60例。对照组口服阿替洛尔片，起始剂量为6.25 mg/次，2次/d，逐渐增加剂量至12.5 mg/次，每日最大剂量为50 mg。治疗组在对照组基础上口服心速宁胶囊，1.92 g/次，3次/d。两组患者均治疗4周。观察两组患者临床疗效，比较治疗前后两组患者室性早搏次数，室性早搏指数，心功能指标左室射血分数（LVEF）、每搏输出量（SV）、左心室舒张末期容积（LVEDV）和左心室舒张末期内径（LVEDD），心率变异性指标RR间期标准差（SDNN）、RR间期平均值标准差（SDANN）和相邻RR间期差值均方根（RMSSD），血管内皮功能指标血栓素B₂（TXB₂）、内皮素-1（ET-1）和一氧化氮（NO）。结果 治疗后，治疗组总有效率明显高于对照组（91.67% vs 76.67%，P＜0.05）。治疗后，两组患者的室性早搏次数较治疗前显著减少，而室性早搏指数明显升高（P＜0.05），且治疗组室性早搏指标明显好于对照组（P＜0.05）。治疗后，两组患者心功能LVEF和SV显著升高，而LVEDV和LVEDD显著降低（P＜0.05），且治疗组心功能指标改善程度优于对照组（P＜0.05）。治疗后，两组患者的心率变异性指标较治疗前均显著升高（P＜0.05），且治疗组SDNN、SDANN、RMSSD均高于对照组（P＜0.05）。治疗后，两组患者血管内皮功能指标较治疗前显著改善（P＜0.05），且治疗组TXB₂、ET-1均低于对照组，而NO高于对照组（P＜0.05）。结论 心速宁胶囊联合阿替洛尔片治疗老年冠心病室性早搏临床疗效显著，可降低室性早搏的发生次数，改善患者心功能指标、心率变异性指标和血管内皮功能指标。

Objective To investigate the clinical efficacy of Xinsuning Capsules combined with atenolol in treatment of ventricular premature contractions in elderly patients with coronary heart disease. Methods Patients (120 cases) with ventricular premature contractions of coronary heart disease in Nanjing Central Hospital from May 2023 to October 2024 were divided into control and treatment group according to random number table method, and each group had 60 cases. Patient in the control group were po administered with Atenolol Tablets, the starting dose was 6.25 mg/time, twice daily, and the dose was gradually increased to 12.5 mg/time with a maximum daily dose of 50 mg. Patient in the treatment group were po administered with Xinsuning Capsules on the basis of the control group, 1.92 g/time, three times daily. Patient in two groups were treated for 4 weeks. After treatment, the clinical evaluations were evaluated, and the frequency of premature ventricular beats, VPI, cardiac function indicators LVEF, SV, LVEDV and LVEDD, heart rate variability indicators SDNN, SDANN and RMSSD, endothelial function indicators TXB₂, ET-1 and NO in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was significantly higher than that in the control group (91.67% vs 76.67%, P < 0.05). After treatment, the frequency of ventricular premature beats in patients in two groups was decreased significantly compared with before treatment, while the VPI increased significantly (P < 0.05), and the indexes of ventricular premature beats in the treatment group were significantly better than that in the control group (P < 0.05). After treatment, LVEF and SV of cardiac function in two groups were significantly increased, while LVEDV and LVEDD were significantly decreased (P < 0.05), and the improvement of cardiac function indicators in the treatment group was better than that in the control group (P < 0.05). After treatment, the heart rate variability indicators in two groups were significantly higher than those before treatment (P < 0.05), and SDNN, SDANN, and RMSSD in the treatment group were higher than those in the control group (P < 0.05). After treatment, the vascular endothelial function indicators in two groups were significantly improved compared with those before treatment (P < 0.05). TXB2 and ET-1 in the treatment group were lower than those in the control group, while NO was higher than that in the control group (P < 0.05). Conclusion The combination of Xinsuning Capsules and Atenolol Tablets has significant clinical efficacy in treating ventricular premature contractions in elderly patients with coronary heart disease. It can reduce the occurrence of premature ventricular contractions, improve patients' cardiac function indicators, heart rate variability indicators, and endothelial function indicators.

R972

南京市卫生科技发展项目（YKK23198）