目的 探讨心宝丸联合琥珀酸美托洛尔缓释片治疗慢性心力衰竭的临床疗效。方法 选取2017年4月—2018年6月邯郸市第二医院收治的慢性心力衰竭患者120例，根据用药的差别分为对照组（60例）和治疗组（60例）。对照组口服琥珀酸美托洛尔缓释片，心功能Ⅱ级者起始2周内，23.75 mg/次，1次/d，2周后，剂量可增至47.5 mg/次，1次/d，每隔2周可加倍剂量，长期治疗用量为190 mg，1次/d；心功能Ⅲ级者起始量11.875 mg/次，1次/d，1～2周后，剂量可加至23.75 mg/次，1次/d，再经2周后，剂量可加至47.5 mg/次，1次/d，对于可耐受高剂量者，每隔2周可加倍剂量，最大190 g/次，1次/d。治疗组在对照组基础上口服心宝丸，心功能Ⅱ级者240 mg/次，3次/d，心功能Ⅲ级者360 mg/次，3次/日。两组均治疗4周。观察两组患者临床疗效，同时比较治疗前后两组患者心功能、血清学指标和6 min步行距离（6WMT）。结果 治疗后，对照组和治疗组临床有效率分别为81.67%、96.67%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者左心室射血分数（LVEF）、6WMT明显升高（P<0.05），左室舒张末期内经（LVEDD）、左心室收缩末期内径（LVESD）和左心室收缩末期容积（LVESV）均明显降低（P<0.05），且治疗组上述心功能指标和6WMT明显好于对照组（P<0.05）。治疗后，两组血清N末端B型钠尿肽原（NT-proBNP）、细胞间粘附分子-1（ICAM-1）、心肌肌钙蛋白I（cTnI）水平均显著降低（P<0.05），血管内皮细胞生长因子（VEGF）、胰岛素样生长因子-1（IGF-1）水平显著升高（P<0.05），且治疗组NT-proBNP、ICAM-1、cTnT、VEGF和IGF-1水平明显好于对照组（P<0.05）。结论 心宝丸联合琥珀酸美托洛尔缓释片治疗慢性心力衰竭不仅可以改善患者心功能，还可促进心肌细胞修复，改善运动耐量。

Objective To investigate the clinical efficacy of Xinbao Pills combined with metoprolol in treatment of chronic heart failure. Methods Patients (120 cases) with chronic heart failure in Handan Second Hospital from April 2017 to June 2018 were divided into control (60 cases) and treatment (60 cases) groups based on different treatments. Patients in the control group were po administered with Metoprolol Succinate Sustained-release Tablets, 23.75 mg/time for the patients with grade Ⅱ cardiac function in the initial 2 weeks, once daily, and the dose can be increased to 47.5 mg/time, and the dose doubled every two weeks, the dosage of long-term treatment was 190 mg/time, once daily. 11.875 mg/time for the patients with grade Ⅲ cardiac function, once daily, and the dose can be increased to 23.75 mg/time after 1-2 weeks, once daily, and increased to 47.5 mg/time after 2 weeks, once daily, the dose doubled every two weeks for tolerable high-dose patients, the maximum dose was 190 mg/time, once daily. Patients in the treatment group were po administered with Xinbao Pills on the basis of the control group, 240 mg/time for the patients with grade Ⅱ cardiac function, 360 mg/time for the patients with grade Ⅲ cardiac function, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and the cardiac function, the serological indexes and 6WMT in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 81.67% and 96.67% respectively, and there were differences between two groups (P < 0.05). After treatment, LVEE and 6WMT in two groups was significantly increased (P < 0.05), LVEDD, LVESD and LVESV were significantly decreased (P < 0.05), and the cardiac function and 6WMT in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the serum NT-proBNP, ICAM-1 and cTnT levels in two groups was significantly decreased (P < 0.05), but VEGF and IGF-1 levels were significantly increased (P < 0.05), and the serological indexes levels in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Xinbao Pills combined with metoprolol in treatment of chronic heart failure can effectively improve the cardiac function, promote cardiomyocyte repair, and improve exercise tolerance.

河北省卫生厅科技计划项目（20181662）