目的 探討托拉塞米聯(lián)合左卡尼汀治療慢性心力衰竭急性加重期的臨床療效。方法 選取2015年3月—2017年1月在濮陽(yáng)市安陽(yáng)地區(qū)醫(yī)院住院治療的慢性心力衰竭急性加重患者96例，隨機(jī)分為對(duì)照組和治療組，每組各48例。對(duì)照組靜脈滴注左卡尼汀注射液，2.0 g/次加至生理鹽水或5%葡萄糖注射液配成100 mL溶液，2次/d。治療組在對(duì)照組治療基礎(chǔ)上靜脈滴注托拉塞米注射液，20 mg/次。兩組均連續(xù)治療1周。觀察兩組的臨床療效，比較兩組治療前后血漿B型利鈉肽原（NT-proBNP）、腎素（PRA）、血管緊張素Ⅱ（AngⅡ）、醛固酮（ALD）及心室肥厚程度。結(jié)果 治療后，對(duì)照組和治療組的總有效率分別為72.9%、91.7%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者血漿NT-proBNP、PRA、AngⅡ、ALD、舒張末期左心室內(nèi)徑（LVEDD）、舒張末期左心室后壁厚度（LVPWT）、室間隔舒張末期厚度（IVST）、明尼蘇達(dá)心衰生活質(zhì)量量表（MLWHF）評(píng)分均顯著下降，6 min步行距離顯著升高，同組治療前后差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，治療組NT-proBNP、PRA、AngⅡ、ALD、LVEDD、LVPWT、IVST、MLWHF水平顯著低于對(duì)照組，6 min步行距離高于對(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 托拉塞米聯(lián)合左卡尼汀治療慢性心力衰竭臨床療效確切，可明顯降低血漿NT-proBNP、PRA、AngⅡ、ALD水平，改善心室重塑，提高患者活動(dòng)能力和生活質(zhì)量，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the therapeutic effect of torsemide combined with levocarnitine in treatment of acute exacerbation of chronic heart failure. Meathods Patients (96 cases) with acute exacerbation of chronic heart failure in Puyang Anyang District Hospital from March 2015 to January 2017 were randomly divided into control (48 cases) and treatment (48 cases) groups. Patients in the control group were iv administered with Levocarnitine Injection, 2.0 g/time added into normal saline or 5% glucose injection 100 mL, twice daily. Patients in the treatment group were iv administered with Torsemide Injection on the basis of the control group, 20 mg/time. Patients in two groups were treated for 1 week. After treatment, the clinical efficacy was evaluated, and the changes of NT-proBNP, PRA, AngⅡ, ALD, and ventricular hypertrophy degree in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 72.9% and 91.7%, respectively, and there was difference between two groups (P < 0.05). After treatment, NT-proBNP, PRA, AngⅡ, ALD, LVEDD, LVPWT, IVST, MLWHF score in two groups were decreased, but 6 min walking distance in two groups were increased, and the difference was statistically significant in the same group (P < 0.05). After treatment, NT-proBNP, PRA, AngⅡ, ALD, LVEDD, LVPWT, IVST, MLWHF score in treatment group were lower than those in the control group, but 6 min walking distance was higher than that in the treatment group, and there was difference between two groups (P < 0.05). Conclusion Torsemide combined with levocarnitine has clinical efficacy in treatment of acute exacerbation of chronic heart failure, and can obviously decrease the plasma NT-proBNP, PRA, Ang Ⅱ, ALD levels, also can improve the ventricular remodeling, and improve the activity and life quality, which has a certain clinical application value.