目的 探討慢性心力衰竭應(yīng)用麝香保心丸聯(lián)合纈沙坦治療的臨床效果。方法 選取2017年3月-2019年5月保定市第二中心醫(yī)院收治的198例慢性心力衰竭患者，隨機分成對照組（n=99）和治療組（n=99）。對照組患者口服纈沙坦膠囊，80 mg/次，1次/d。治療組在對照組基礎(chǔ)上口服麝香保心丸，2丸/次，3次/d。兩組均連續(xù)治療4周。比較兩組臨床療效；治療前后對兩組患者行常規(guī)經(jīng)胸超聲心動圖檢查[主要觀察左心室舒張末期、收縮末期容積（LVEDV和LVESV）及左心室射血分?jǐn)?shù)（LVEF）變化]，測量6 min步行距離（6MWD），行無創(chuàng)血流動力學(xué)監(jiān)測[主要觀察肺動脈楔壓（PCWP）、總外周阻力（TPR）、心收縮力指數(shù)（HI）、心輸出量（CO）、心臟指數(shù)（CI）變化]，分別采用免疫熒光法和硝酸還原酶法檢測血漿B型利鈉肽（BNP）、一氧化氮（NO）濃度，采取放射免疫法測定血漿血管緊張素Ⅱ（AngⅡ）、醛固酮（ALD）、內(nèi)皮素-1（ET-1）水平。結(jié)果 治療組總有效率94.9%較對照組85.9%顯著提高（P<0.05）。兩組治療后LVEDV、LVESV較治療前均顯著縮小，LVEF、6MWD則均顯著升高（P<0.05）；但治療組以上參數(shù)（LVEDV、LVESV、LVEF、6MWD）的改善效果均更為突出（P<0.05）。與治療前對比，兩組治療后PCWP、TPR均顯著降低（P<0.05），而HI、CO、CI均顯著增高（P<0.05）；且治療后，治療組無創(chuàng)血流動力學(xué)參數(shù)（PCWP、TPR、HI、CO、CI）的改善效果均顯著優(yōu)于對照組同期（P<0.05）。兩組治療后血漿BNP、AngⅡ、ALD、ET-1、NO水平均顯著低于治療前（P<0.05），且治療組下降更顯著（P<0.05）。結(jié)論 麝香保心丸聯(lián)合纈沙坦治療慢性心力衰竭的整體療效顯著，能有效改善患者的心臟結(jié)構(gòu)和功能，糾正機體血流動力學(xué)異常，抑制RAAS活性，正性調(diào)控血管內(nèi)皮功能，提高運動耐力，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of Shexiang Baoxin Pills combined with valsartan in treatment of chronic heart failure. Methods 198 Patients with chronic heart failure admitted to Baoding Second Central Hospital from March 2017 to May 2019 were randomly divided into control group (n=99) and treatment group (n=99). Patients in the control group were po administered with Valsartan Capsules, 80 mg/time, once daily. Patients in the treatment group were po administered with Valsartan Capsules, 2 pills/time, three times daily. All subjects were treated for 4 weeks. The clinical effects of the two groups were compared. Before and after treatment, two groups of subjects were examined by conventional transthoracic echocardiography[mainly observing the changes of left ventricular end diastole, end systole volume (LVEDV and LVESV) and left ventricular ejection fraction (LVEF)], and 6 min walking distance (6MWD) was measured. Noninvasive hemodynamic monitoring was performed[mainly to observe changes in pulmonary wedge pressure (PCWP), total peripheral resistance (TPR), cardiac contractility index (HI), cardiac output (CO), cardiac index (CI)]. Plasma concentrations of B-type natriuretic peptide (BNP) and nitric oxide (NO) were detected by immunofluorescence and nitrate reductase methods respectively, and plasma levels of angiotensin II (Ang II), aldosterone (ALD), endothelin -1(ET-1) were determined by radioimmunoassay. Results The total effective rate of the treatment group 94.9% was significantly higher than that of the control group 85.9% (P<0.05). After treatment, LVEDV and LVESV decreased significantly, 6MWD and LVEF increased significantly (P<0.05) in both groups. However, the improvement effect of the above parameters (LVEDV, LVESV, LVEF, 6MWD) in the treatment group is more prominent (P<0.05). Compared with before treatment, PCWP and TPR of the two groups decreased significantly after treatment, but HI, CO and CI increased significantly (P<0.05). After treatment, the improvement effect of non-invasive hemodynamic parameters (PCWP, TPR, HI, CO, and CI) in the treatment group was significantly better than those in the control group at the same time (P<0.05). The levels of plasma BNP, AngⅡ, ALD, ET-1 and NO in the two groups after treatment were significantly lower than those before treatment (P<0.05), and the decrease in the treatment group was more significant (P<0.05). Conclusion Shexiang Baoxin Pills combined with valsartan has definite overall curative effect in treatment of chronic heart failure, and can obviously promote the improvement of the patient's cardiac structure and function, correct the abnormal body hemodynamics, inhibit the activity of renin-angiotensin-aldosterone system (RAAS), protect vascular endothelial function, enhance exercise endurance, which has a certain clinical application value.

R972