目的 探討伊伐布雷定聯(lián)合米力農(nóng)治療慢性心力衰竭的臨床療效。方法 選取2020年1月—2022年1月中國(guó)人民解放軍聯(lián)勤保障部隊(duì)第九八一醫(yī)院治療的118例心力衰竭患者，按照隨機(jī)數(shù)字表法將患者分為對(duì)照組和治療組，每組各59例。對(duì)照組患者靜脈滴注米力農(nóng)注射液，10 mg加入生理鹽水50 mL，微量泵以0.375～0.750µg/(kg∙min)維持，1次/d。治療組患者在對(duì)照組的基礎(chǔ)上口服鹽酸伊伐布雷定片，5 mg/次，2次/d。兩組連續(xù)用藥7 d。觀察兩組的治療效果和臨床癥狀改善時(shí)間，比較兩組患者治療前后左室收縮期內(nèi)徑（LVESV）、左室射血分?jǐn)?shù)（LVEF）、左室舒張末期內(nèi)徑（LVEDV）、血清可溶性生長(zhǎng)刺激表達(dá)基因2蛋白（sST2）、白細(xì)胞介素-6（IL-6）、氨基末端B型鈉尿肽（NT-proBNP）、腫瘤壞死因子-α（TNF-α）水平的變化情況。比較兩組不良反應(yīng)情況。結(jié)果 治療后，治療組患者總有效率是98.31%，顯著高于對(duì)照組的83.05%（P＜0.05）。治療后，治療組心慌、胸悶、氣短、下肢水腫等癥狀緩解時(shí)間均短于對(duì)照組（P＜0.05）。治療后，兩組LVEF均較治療前顯著升高，而LVESV、LVEDV顯著降低（P＜0.05）；治療后，治療組心功能指標(biāo)改善優(yōu)于對(duì)照組（P＜0.05）。治療后，兩組sST2、IL-6、NT-proBNP、TNF-α水平均較治療前顯著降低（P＜0.05）；治療后，治療組血清學(xué)指標(biāo)低于對(duì)照組（P＜0.05）。治療組不良反應(yīng)發(fā)生率是6.78%，顯著低于對(duì)照組的15.25%（P＜0.05）。結(jié)論 伊伐布雷定聯(lián)合米力農(nóng)注射液治療慢性心力衰竭效果確切，能明顯緩解患者臨床癥狀，有效改善心功能狀態(tài)，并可降低炎性反應(yīng)，值得臨床推廣應(yīng)用。

Objective To investigate the therapeutic effect of ivabradine combined with milrinone in treatment of chronic heart failure. Methods A total of 118 patients with heart failure treated in 981 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from January 2020 to January 2022 were selected and divided into control group and treatment group according to random number table method, with 59 cases in each group. Patients in the were iv administered with Milrinone Injection, 10 mg was added into 50 mL 0.9% normal saline, and the micropump was maintained at 0.375-0.75 µg/(kg·min), once daily. Patients in the treatment group were po administered with Ivabradine Hydrochloride Tablets on the basis of the control group, 5 mg/time, twice daily. Patients in two groups were treated for 7 d. After treatment, the treatment effect and improvement time of clinical symptoms of the two groups were observed. After treatment, left ventricular systolic diameter (LVESV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDV), serum soluble growth stimulation expression gene 2 protein (sST2), interleukin 6 (IL-6), amino-terminal B-type natriuretic peptide (NT-probNP), and tumor necrosis factor α (TNF-α) were compared between the two groups before and after treatment. The adverse reactions of two groups were compared. Results After treatment, the total effective rate in the treatment group was 98.31%, significantly higher than that in the control group (83.05%, P < 0.05). After treatment, the relief time of palpitation, chest tightness, shortness of breath, and lower limb edema in the treatment group was shorter than that in the control group (P < 0.05). After treatment, LVEF in both groups was significantly increased compared with before treatment, while LVESV and LVEDV were significantly decreased (P < 0.05). After treatment, the improvement of cardiac function index in the treatment group was better than that in the control group (P < 0.05). After treatment, the levels of sST2, IL-6, NT-probNP and TNF-α in two groups were significantly decreased compared with before treatment (P < 0.05). After treatment, the serum index of the treatment group was lower than that of the control group (P < 0.05). The incidence of adverse reactions in treatment group was 6.78%, significantly lower than 15.25% in control group (P < 0.05).Conclusions Ivabradine combined with milrinone has exact effect in treatment of chronic heart failure, and can significantly relieve the clinical symptoms of patients, effectively improve the cardiac function, and reduce the inflammatory response, which is worthy of clinical application.

R972

承德市科技支撐項(xiàng)目(201904A061)