目的 探討心寶丸聯(lián)合沙庫(kù)巴曲纈沙坦治療慢性心力衰竭的臨床療效。方法 選取2020年7月-2021年7月榆林市第一醫(yī)院收治的64例慢性心力衰竭患者,按照隨機(jī)數(shù)字表法分為對(duì)照組和治療組,每組各32例。對(duì)照組口服沙庫(kù)巴曲纈沙坦鈉片,50 mg/次、2次/d為初始劑量,連服2周后增至100 mg/次、2次/d并維持。治療組在對(duì)照組基礎(chǔ)上口服心寶丸,NYHA心功能分級(jí)Ⅱ級(jí)者4丸/次,3次/d;NYHA心功能分級(jí)Ⅲ級(jí)者6丸/次,3次/d。兩組療程均為8周。觀(guān)察兩組的臨床療效,比較兩組36項(xiàng)健康調(diào)查簡(jiǎn)表(SF-36)總分,6分鐘步行距離(6MWD),超聲心動(dòng)圖指標(biāo)[左室射血分?jǐn)?shù)(LVEF)、二尖瓣口血流圖舒張?jiān)缙诤褪鎻埻砥谘鞣逯抵?E/A)、左室心肌做功指數(shù)(Tei指數(shù))、左心房前后徑(LAD)],外周血中性粒細(xì)胞與淋巴細(xì)胞比值(NLR)以及血清C反應(yīng)蛋白(CRP)、同型半胱氨酸(Hcy)、B型利鈉肽(BNP)、醛固酮(ALD)水平。結(jié)果 治療后,治療組總有效率是93.75%,顯著高于對(duì)照組的75.00%(P<0.05)。治療后,兩組SF-36總分均顯著增加,6MWD均顯著延長(zhǎng)(P<0.05),且以治療組改善更顯著(P<0.05)。治療后,兩組LVEF、E/A均顯著增加,左室Tei指數(shù)、LAD均顯著降低(P<0.05);以治療組改善更顯著(P<0.05)。治療后,兩組外周血NLR和血清CRP、Hcy、BNP、ALD水平均顯著下降(P<0.05);且治療后,治療組外周血NLR和血清CRP、Hcy、BNP、ALD水平均顯著低于對(duì)照組(P<0.05)。結(jié)論 心寶丸聯(lián)合沙庫(kù)巴曲纈沙坦能有效提高慢性心力衰竭患者的整體療效,減輕機(jī)體炎癥反應(yīng)和心肌損害,利于改善患者心功能與運(yùn)動(dòng)耐力,提高生活質(zhì)量,且安全性好。

Objective To investigate the clinical efficacy of Xinbao Pills combined with sacubitril valsartan in treatment of chronic heart failure. Methods Sixty-four patients with chronic heart failure admitted to the First Hospital of Yulin from July 2020 to July 2021 were selected and divided into control group and treatment group according to random number table method, with 32 cases in each group. Patients in the control group were po administered with Sacubitril Valsartan Sodium Tablets. The initial dose was 50 mg/time, twice daily, which was increased to 100 mg/time and twice daily after 2 weeks and maintained. Patients in the treatment group were po administered with Xinbao Pills on the basis of the control group. NYHA cardiac function grade Ⅱ patients took 4 pills/time, 3 times daily, and NYHA cardiac function grade Ⅲ patients took 6 pills/time, 3 times daily. The treatment course of both groups was 8 weeks. After treatment, the clinical efficacy was evaluated, 36 health survey (SF-36) score, 6 minutes walking distance (6 MWDS), echocardiography index [left ventricular ejection fraction (LVEF), mitral valve orifice flow diagram diastolic peak ratio of early and late diastolic blood flow (E/A), left ventricular cardiac work index (Tei index), before and after the left atrium diameter (LAD)], peripheral blood neutrophil to lymphocyte ratio (NLR), serum C-reactive protein (CRP), homocysteine (Hcy), B-type natriuretic peptide (BNP), aldosterone (ALD) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 93.75%, which was significantly higher than that of the control group (75.00%, P＜0.05). After treatment, the total score of SF-36 and 6MWD were significantly increased in both groups (P＜0.05), and the improvement was more significant in the treatment group (P＜0.05). After treatment, LVEF and E/A were significantly increased, while left ventricular Tei index and LAD were significantly decreased in both groups (P＜0.05). The improvement was more significant in the treatment group (P＜0.05). After treatment, the levels of peripheral blood NLR and serum CRP, Hcy, BNP, and ALD in both groups were significantly decreased (P＜0.05). After treatment, the levels of peripheral blood NLR and serum CRP, Hcy, BNP and ALD in the treatment group were significantly lower than those in the control group (P＜0.05). Conclusion Xinbao Pills combined with sacubitril valsartan can effectively improve the overall efficacy of patients with chronic heart failure, can reduce inflammation and myocardial damage, improve patients’ heart function and exercise endurance, improve quality of life, which has good safety.

R914

榆林市2022年度科學(xué)技術(shù)研究與開(kāi)發(fā)項(xiàng)目(YF-2022-33)