目的 探討左西孟旦聯(lián)合單硝酸異山梨酯治療頑固性心力衰竭的臨床療效。方法 選取2014年1月—2016年10月在河南省中醫(yī)院接受治療的頑固性心力衰竭患者78例，根據(jù)治療方案的不同分為對照組（39例）和治療組（39例）。對照組靜脈泵入單硝酸異山梨酯注射液，20 mg加入5%葡萄糖溶液50 mL中，1次/d。治療組在對照組的基礎(chǔ)上靜脈泵入左西孟旦注射液，初始負荷劑量為12 μg/kg，持續(xù)時間> 10 min，然后以0.1 μg/（kg·min）維持。兩組患者均治療14 d。比較兩組患者治療前后臨床療效、心功能指標和血清細胞因子水平。結(jié)果 治療后，對照組總有效率為64.10%，顯著低于治療組的87.18%，兩組比較差異具有統(tǒng)計學意義（P< 0.05）。治療后，兩組患者左心室射血分數(shù)（LVEF）和心臟指數(shù)（CI）顯著升高，左室舒張末期內(nèi)徑（LVEDD）明顯降低，同組比較差異具有統(tǒng)計學意義（P< 0.05）；且治療組心功能指標明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學意義（P< 0.05）。治療后，兩組患者血清N-末端B型利鈉肽前體（NT-proBNP）、超敏C反應(yīng)蛋白（hs-CRP）、白細胞介素-6（IL-6）和腫瘤壞死因子-α（TNF-α）水平均低于治療前，同組比較差異具有統(tǒng)計學意義（P< 0.05）；且治療組患者細胞因子水平比對照組降低的更顯著，兩組比較差異具有統(tǒng)計學意義（P< 0.05）。結(jié)論 左西孟旦聯(lián)合單硝酸異山梨酯治療頑固性心力衰竭的臨床效果明顯，可明顯改善患者心功能和機體細胞因子水平，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of levosimendan combined with isosorbide mononitrate in treatment of refractory heart failure. Methods Patients (78 cases) with refractory heart failure in Henan Province Hospital of TCM from January 2014 to October 2016 were divided into control (39 cases) and treatment (39 cases) groups based on different treatments. Patients in the control group were intravenous pumping administered with Isosorbide Mononitrate Injection, 20 mg added into 5% glucose solution 50 mL, once daily. Patients in the treatment group were intravenous pumping administered with Levosimendan Injection on the basis of the control group, the initial load dose was 12 μg/kg, and the time of which was more than 10 min, then maintained the treatment with 0.1 μg/(kg·min). Patients in two groups were treated for 14 d. After treatment, clinical efficacy, cardiac function index, and serum cytokines in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 64.10%, which were significantly lower than 87.18% in the treatment group, and there were differences between two groups (P < 0.05). After treatment, the LVEF and CI in two groups were significantly increased, but LVEDD was significantly decreased, and there were differences in the same group (P < 0.05). And the cardiac function indexes in treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the serum hs-CRP, IL-6, TNF-α, and NT-proBNP levels in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And these serum cytokines levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Levosimendan combined with isosorbide mononitrate has obvious clinical effect in treatment of refractory heart failure, and can significantly improve the cardiac function and cytokines levels, which has a certain clinical application value.