目的 探討終末期心力衰竭應(yīng)用穩(wěn)心顆粒聯(lián)合重組人腦利鈉肽治療的臨床效果。方法 選取2018年2月—2019年2月阿壩州人民醫(yī)院收治的86例終末期心力衰竭患者，隨機分為對照組（n=43）和治療組（n=43）。對照組給予凍干重組人腦利鈉肽，首先以1.5 μg/kg的負荷劑量靜脈沖擊后，繼以0.007 5 μg/(kg·min)的給藥速率連續(xù)靜脈滴注，連用3 d后繼續(xù)常規(guī)治療。治療組在對照組基礎(chǔ)上口服穩(wěn)心顆粒，1袋/次，3次/d，開水沖服。兩組均連續(xù)治療4周。比較兩組臨床療效和呼吸困難緩解時間，治療前后呼吸困難評分、超聲心動圖指標[左心室舒張、收縮末期容積（LVEDV和LVESV）及左心室射血分數(shù)（LVEF）]、血流動力學指標和血漿N末端B型利鈉肽原（NT-proBNP）、C反應(yīng)蛋白（CRP）、內(nèi)皮素-1（ET-1）水平變化情況。結(jié)果 治療組總有效率為90.7%，顯著高于對照組74.4%，兩組比較差異有統(tǒng)計學意義（P<0.05）。治療組呼吸困難緩解時間顯著短于對照組（P<0.05）；兩組治療后呼吸困難評分較治療前均顯著增高（P<0.05），且治療組治療后呼吸困難評分顯著高于對照組同期（P<0.05）。與治療前比較，兩組治療后LVEDV、LVESV值均顯著降低（P<0.05），LVEF值則均顯著升高（P<0.05）；且治療后，治療組超聲心動圖參數(shù)（LVEDV、LVESV、LVEF）的改善效果均顯著優(yōu)于對照組同期（P<0.05）。與治療前相比，兩組治療后心指數(shù)（CI）、心輸出量（CO）及心臟收縮力指數(shù)（HI）值均顯著上升（P<0.05），而舒張功能指數(shù)（O/C）、肺動脈楔壓（PAWP）和總外周阻力（TPR）值均顯著下降（P<0.05）；但治療后，治療組血流動力學的改善效果更顯著（P<0.05）。兩組治療后血漿NT-proBNP、CRP、ET-1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 穩(wěn)心顆粒聯(lián)合重組人腦利鈉肽治療終末期心力衰竭的整體療效確切，能迅速有效地緩解患者的呼吸困難，改善心臟結(jié)構(gòu)和功能，穩(wěn)定血流動力學狀態(tài)，正性調(diào)節(jié)血管內(nèi)皮功能，減輕病情的嚴重程度，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of Wenxin Granules combined with recombinant human brain natriuretic peptide in treatment of end-stage heart failure. Methods 86 Patients with end-stage heart failure admitted to People's Hospital of Aba Prefecture from February 2018 to February 2019 were randomly divided into control group (n=43) and treatment group (n=43). Patients in the control group were treated with Lyophilized Recombinant Human Brain Natriuretic Peptide, intravenous impact was administered at 1.5 μg/kg, followed by continuous intravenous infusion at 0.007 5 μg/(kg∙min) for 3 days, followed by routine treatment. The treatment group was po administered with Wenxin Granules, 1 bag/time, three times daily. All patients were treated for 14 days. The clinical efficacy and dyspnea relief time of the two groups were compared. The changes of dyspnea score, echocardiographic indexes (LVEDV, LVESV, and LVEF), hemodynamic indexes, NT-proBNP, CRP, and ET-1 were compared before and after treatment. Results The total effective rate of the treatment group was 90.7%, significantly higher than that of the control group 74.4% (P<0.05). The remission time of dyspnea in the treatment group was significantly shorter than that in the control group (P<0.05). The dyspnea score after treatment in both groups was significantly higher than that before treatment (P<0.05), and the dyspnea score after treatment in the treatment group was significantly higher than that in the control group at the same time (P<0.05). Compared with before treatment, LVEDV and LVESV values in both groups decreased significantly (P<0.05), but LVEF values increased significantly (P<0.05). After treatment, the improvement effect of echocardiography parameters (LVEDV, LVESV, LVEF) in the treatment group was significantly better than that in the control group (P<0.05). Compared with before treatment, the cardiac index (CI), cardiac output (CO) and cardiac contractility index (HI) of the two groups increased significantly after treatment (P < 0.05), while the diastolic function index (O/C), pulmonary artery wedge pressure (PAWP) and total peripheral resistance (TPR) decreased significantly (P<0.05). However, after treatment, the hemodynamic improvement effect in the treatment group was more significant (P < 0.05). The plasma levels of NT-proBNP, CRP, ET-1 in the two groups after treatment were significantly lower than before treatment (P<0.05), and the decrease in the treatment group was more significant (P<0.05). Conclusion Wenxin Granules combined with recombinant human brain natriuretic peptide has overall efficacy in treatment of end-stage heart failure, and can quickly and effectively relieve patients' dyspnea, improve cardiac structure and function, stabilize hemodynamic state, positively regulate vascular endothelial function, and reduce the severity of the disease, which has a certain clinical application value.

R972