目的 探討托拉塞米注射液聯(lián)合酒石酸美托洛爾注射液治療老年退行性心臟瓣膜病心力衰竭的臨床療效。方法 選取2015年1月—2017年1月在聊城市第二人民醫(yī)院心胸外科接受治療的老年退行性心臟瓣膜病心力衰竭患者86例，入選患者采用隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各43例。對(duì)照組靜脈滴注酒石酸美托洛爾注射液，15 mL加入到0.9%氯化鈉注射液500 mL中，1次/d。治療組在對(duì)照組基礎(chǔ)上靜脈滴注托拉塞米注射液，初始劑量10 mg/d，加入到0.9氯化鈉注射液250 mL，若療效不如意可增加至20 mg/d，最大劑量為40 mg/d。兩組患者均治療1周。觀察兩組的臨床療效，比較兩組的心功能指標(biāo)和血清細(xì)胞因子情況。結(jié)果 治療后，對(duì)照組和治療組的總有效率分別為81.39%、97.67%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組左室射血分?jǐn)?shù)（LVEF）顯著上升，左室舒張末期內(nèi)徑（LVEDD）和左室收縮末期內(nèi)徑（LVESD）明顯下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）；且治療組這些觀察指標(biāo)的改善程度明顯優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組血清腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素-1β（IL-1β）、白細(xì)胞介素-6（IL-6）和N末端腦鈉肽原（NT-proBNP）水平均顯著下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P< 0.05）；且治療組這些觀察指標(biāo)明顯低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）。結(jié)論 托拉塞米注射液聯(lián)合酒石酸美托洛爾注射液治療老年退行性心臟瓣膜病心力衰竭具有較好的臨床療效，可有效改善心臟功能，調(diào)節(jié)血清細(xì)胞因子水平，改善炎癥反應(yīng)，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect of Torsemide Injection combined with Metoprolol Tartrate Injection in treatment of heart failure of senile degenerative valvular heart disease. Methods Patients (86 cases) with heart failure of senile degenerative valvular heart disease in Department of Cardiothoracic Surgery of Liaocheng Second People's Hospital from January 2015 to January 2017 were randomly divided into control and treatment groups, and each group had 43 cases. Patients in the control group were iv administered with Metoprolol Tartrate Injection, 15 mL added into normal saline 500 mL, once daily. Patients in the treatment group were iv administered with Torsemide Injection on the basis of the control group, starting dosage 10 mg/d added into normal saline 250 mL, once daily, if the effect was not satisfactory, it could be increased to 20 mg/d, and the maximum dose was 40 mg/d. Patients in two groups were treated for 1 weeks. After treatment, the clinical efficacies were evaluated, and cardiac function index and serum cytokines in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 81.39% and 97.67%, respectively, and there was difference between two groups (P < 0.05). After treatment, the LVEF in two groups were significantly increased, but the LVEDD and LVESD in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the levels of TNF-α, IL-1β, IL-6, and NT-proBNP in two groups were significantly decreased, and the difference was statistically significant in the same group (P <0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Torasemide combined with metoprolol has clinical curative effect in treatment of heart failure of senile degenerative valvular heart disease, can improve heart function, regulate serum cytokine level, and improve inflammatory reaction, which has a certain clinical application value.