目的 探討左西孟旦聯(lián)合氫氯噻嗪治療重癥心力衰竭的臨床療效。方法 選取2020年7月—2023年7月復(fù)旦大學(xué)附屬中山醫(yī)院青浦分院重癥監(jiān)護(hù)室收治的100例重癥心力衰竭患者，按隨機(jī)數(shù)字法將所有患者分為對(duì)照組和治療組，每組各50例。對(duì)照組患者口服氫氯噻嗪片，50 mg/次，2次/d。治療組在對(duì)照組的治療基礎(chǔ)上靜脈滴注左西孟旦注射液，5 mL加入5%葡萄糖注射液500 mL中。兩組用藥7 d。觀察兩組的臨床療效和臨床癥狀改善時(shí)間，比較兩組治療前后心功能指標(biāo)、生活質(zhì)量綜合評(píng)定問(wèn)卷調(diào)查表（CQOLI-74）評(píng)分和血清細(xì)胞因子水平的變化情況。結(jié)果 治療后，治療組總有效率是98.0%，顯著高于對(duì)照組的82.0%（P＜0.05）。治療后，治療組呼吸困難、乏力、氣促、下肢水腫好轉(zhuǎn)時(shí)間均短于對(duì)照組（P＜0.05）。治療后，兩組左室射血分?jǐn)?shù)（LVEF）、心排血量（CO）、GQOLI-74評(píng)分均顯著高于同組治療前（P＜0.05）；治療后，治療組LVEF、CO、GQOLI-74評(píng)分高于對(duì)照組（P＜0.05）。治療后，兩組β型腦鈉肽（BNP）、可溶性生長(zhǎng)刺激表達(dá)基因2蛋白（sST2）、同型半胱氨酸（Hcy）、胱抑素C（CysC）水平均較同組治療前顯著降低（P＜0.05）；治療后，治療組BNP、sST2、Hcy、CysC水平低于對(duì)照組（P＜0.05）。結(jié)論 左西孟旦聯(lián)合氫氯噻嗪治療重癥心力衰竭有較好的臨床療效，能有效改善患者的臨床癥狀，增強(qiáng)心功能指標(biāo)，降低機(jī)體炎性反應(yīng)，值得臨床借鑒應(yīng)用。

Objective To explore the clinical study of levosimendan combined with hydrochlorothiazide in treatment of severe heart failure. Methods A total of 100 patients with severe heart failure admitted to the Intensive Care Unit of Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from July 2020 to July 2023 were selected and divided into control group and treatment group by random number method, with 50 cases in each group. Patients in the control group were po administered with Hydrochlorothiazide Tablets, 50 mg/time, twice daily. Patients in the treatment group were iv administered with Levosimendan Injection on the basis of the control group, 5 mL added to 5% glucose injection 500 mL. Both groups were treated for 7 d. The clinical efficacy and improvement time of clinical symptoms in two groups were observed, and the changes of cardiac function index, CQOLI-74 score and serum cytokine level before and after treatment were compared between two groups. Results After treatment, the total effective rate of the treatment group was 98.0%, which was significantly higher than that of control group (82.0%, P＜0.05). After treatment, the improvement time of dyspnea, fatigue, shortness of breath and lower limb edema in treatment group was shorter than that in the control group (P＜0.05). After treatment, left ventricular ejection fraction (LVEF), cardiac output (CO) and GQOLI-74 score in two groups were significantly higher than before treatment (P＜0.05). After treatment, LVEF, CO and GQOLI-74 scores in the treatment group were higher than those in control group (P＜0.05). After treatment, the levels of β-type brain natriuretic peptide (BNP), soluble growth stimulation expression gene-2 protein (sST2), homocysteine (Hcy) and cystatin C (CysC) in two groups were significantly decreased compared with those before treatment (P＜0.05). After treatment, the levels of BNP, sST2, Hcy and CysC in the treatment group were lower than those in control group (P＜0.05). Conclusion Levosimendan combined with hydrochlorothiazide has good clinical effect in treatment of severe heart failure, and can effectively improve the clinical symptoms of patients, enhance the index of cardiac function, reduce the inflammatory response of the body, which is worthy of clinical application.

R972

上海市青浦區(qū)衛(wèi)生健康委員會(huì)科研課題計(jì)劃（QWJ2022-16）