目的 探討參附注射液聯(lián)合依諾肝素鈉治療急性心肌梗死并心力衰竭的療效。方法 選擇2016年8月—2018年5月銅川市人民醫(yī)院治療的334例急性心肌梗死并心力衰竭患者作為研究對(duì)象，隨機(jī)將其分為觀察組（174例）與對(duì)照組（160例）。對(duì)照組患者使用注射用依諾肝素鈉，75歲以下患者起始靜脈負(fù)荷30 mg，之后每12 h皮下注射1 mg/kg；75歲以上患者直接每12 h皮下注射0.75 mg/kg。觀察組在對(duì)照組的基礎(chǔ)上靜脈滴注參附注射液40 mL，1次/d。兩組均連續(xù)治療10 d后評(píng)價(jià)療效。比較兩組的心肌酶譜、超聲心動(dòng)圖檢查、血漿氨基末端前體腦鈉肽（NT-proBNP）、內(nèi)皮素-1（ET-1）改善情況及30 d內(nèi)的主要心臟事件（MACE）和出血并發(fā)癥發(fā)生情況。結(jié)果 治療后，兩組天冬氨酸氨基轉(zhuǎn)移酶（AST）、肌酸激酶MB同工酶（CK-MB）、α-羥丁酸脫氫酶（α-HBDH）均顯著下降（P<0.05），觀察組顯著低于對(duì)照組（P<0.05）。治療后，兩組LVEF顯著升高，LVDd均明顯降低（P<0.05），而對(duì)照組CO、E/A無(wú)明顯改善，觀察組以上指標(biāo)均顯著優(yōu)于對(duì)照組（P<0.05）。治療后，兩組血漿NT-proBNP、ET-1水平均顯著下降（P<0.05），觀察組下降顯著優(yōu)于對(duì)照組（P<0.05）。觀察組MACE發(fā)生率顯著低于對(duì)照組（P<0.05）。兩組出血并發(fā)癥比較無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 急性心肌梗死并心力衰竭使用依諾肝素鈉抗凝出血并發(fā)癥少，安全性高，同時(shí)加用參附注射液可顯著改善心肌酶譜，改善左心室功能，提高預(yù)后。

Objective To investigate the effect of Shenfu Injection combined with enoxaparin sodium in treatment of acute myocardial infarction with heart failure. Methods Patients (334 cases) with acute myocardial infarction complicated with heart failure in Tongchuan People's Hospital from August 2016 to May 2018 were randomly divided into observation group (174 cases) and control group (160 cases). Patients in the control group were given Enoxaparin Sodium for Injection. Patients under 75 years of age were given 30 mg intravenous load and subcutaneously injected 1 mg/kg every 12 h. Patients over 75 years of age were given 0.75 mg/kg subcutaneously every 12 h. Patients in the observation group were iv administered with Shenfu Injection 40 mL on the basis of the control group, once daily. Efficacy was evaluated after continuous treatment for 10 d in both groups. The improvement of myocardial enzymes, echocardiography, plasma NT-proBNP and ET-1 levels, MACE, and bleeding complications within 30 days were compared between two groups. Results After treatment, the levels of AST, CK-MB and α-HBDH in two groups were significantly decreased (P<0.05), while those in the observation group were significantly lower than those in the control group (P<0.05). After treatment, LVEF were significantly increased in two groups, LVDd were decreased (P<0.05), but CO and E/A did not improve significantly in the control group. The above indexes in the observation group were significantly better than those in the control group (P<0.05). After treatment, the levels of NT-proBNP and ET-1 in plasma of the two groups were significantly decreased (P<0.05), and the levels of NT-proBNP and ET-1 in the observation group was significantly lower than that in the control group (P<0.05). The incidence of MACE in the observation group was significantly lower than that in the control group (P<0.05).There was no significant difference in bleeding complications between the two groups. Conclusion Enoxaparin sodium for anticoagulant bleeding in patients with acute myocardial infarction and heart failure has few complications and high safety. In addition, shenfu injection can significantly improve myocardial enzyme profile, improve left ventricular function and improve prognosis.