目的 探究桂哌齊特聯(lián)合沙庫巴曲纈沙坦治療射血分數(shù)降低心力衰竭（HFrEF）的臨床效果。方法 回顧性選取 2019年6月—2020年9月解放軍第九六〇醫(yī)院收治的80例HFrEF患者作為研究對象，根據(jù)治療方法分為試驗組、對照組，各40例。對照組患者采用沙庫巴曲纈沙坦片治療，初始劑量為50 mg/次，口服，2次/d，之后根據(jù)患者情況每2～4周劑量倍增1次，最大劑量不超過200 mg/次。試驗組患者在對照組基礎上加用馬來酸桂哌齊特注射液240 mg，馬來酸桂哌齊特注射液與250 mL0.9%氯化鈉注射液混合，靜脈滴注，1次/d。兩組均治療4周。比較兩組療效及兩組患者治療前后心功能、6 min步行試驗距離（6MWT）、心衰標志物、左室重構情況，比較治療后兩組不良心血管事件（MACE）發(fā)生率及治療期間不良反應發(fā)生率。結果 試驗組總有效率為92.50%顯著高于對照組的75.00%（P<0.05）；治療后兩組心排血量（CO）、左室射血分數(shù)（LVEF）均顯著增加（P<0.05），左心室舒張末期內(nèi)徑（LVEDD）水平均顯著降低（P<0.05），血清可溶性生長刺激表達基因2蛋白（sST2）、N末端腦鈉肽原（NT-proBNP）、胱抑素C （Cys C）、金屬蛋白酶抑制劑-1 （TIMP-1）、基質金屬蛋白酶-9（MMP-9）水平均顯著降低（P<0.05），6MWT顯著延長（P<0.05）。治療后試驗組CO、LVEF高于對照組（P<0.05），LVEDD低于對照組（P<0.05），6MWT長于對照組（P<0.05）；治療后試驗組血清sST2、NT-proBNP、CysC、TIMP-1、MMP-9水平低于對照組（P<0.05）。兩組MACE發(fā)生率、不良反應發(fā)生率比較，差異無統(tǒng)計學意義（P>0.05）。結論 馬來酸桂哌齊特注射液聯(lián)合沙庫巴曲纈沙坦治療HFrEF患者效果顯著，可有效提高患者運動耐力及心功能，降低心衰標志物水平，逆轉心室重構，且安全性較高。

Objective To investigate the clinical effect of cinepazide combined with sacubatrovalsartan in the treatment of ejection fraction reduced heart failure (HFrEF). Methods Total 80 patients with HFrEF treated in the 960 Hospital of the PLA from June 2019 to September 2020 were retrospectively selected as the research objects. According to the treatment methods, they were divided into experimental group and control group, with 40 cases in each group. Patients in the control group were treated with Sacubatrovalsartan Tablets. The initial dose was 50 mg/time, orally, twice a day. Then, according to the patient's situation, the dose doubled once every 2—4 weeks, and the maximum dose did not exceed 200 mg/time. On the basis of the control group, the patients in the experimental group were added with Cinepazide Maleate Injection, 240 mg Cinepazide Maleate Injection and 250 mL 0.9% sodium chloride injection, intravenous drip, once a day. Both groups were treated for 4 weeks. The curative effects of the two groups were compared. The cardiac function, 6-min walking test distance (6MWT), markers of heart failure and left ventricular remodeling of the two groups were compared before and after treatment. The incidence of adverse cardiovascular events (MACE) and adverse reactions during treatment were compared between the two groups. Results The total effective rate in the experimental group was 92.50%, which was significantly higher than 75.00% in the control group (P<0.05). After treatment, cardiac output (CO), left ventricular ejection fraction (LVEF) increased significantly (P<0.05), left ventricular end diastolic diameter (LVEDD) decreased significantly (P<0.05) in two groups. After treatment, the levels of serum soluble growth stimulating gene 2 protein (sST2), Nterminal pro brain natriuretic peptide (NT proBNP), Cystatin C (Cys C), metalloproteinase inhibitor-1 (TIMP-1) and matrix metalloproteinase-9 (MMP-9) decreased significantly (P<0.05) in two groups, and 6MWT prolonged significantly (P<0.05). After treatment, CO and LVEF in the experimental group were higher than those in the control group (P<0.05), LVEDD was lower than that in the control group (P<0.05), and 6MWT was longer than that in the control group (P<0.05). After treatment, the levels of serum sST2, NT proBNP, Cys C, TIMP-1 and MMP-9 in the experimental group were lower than those in the control group (P<0.05). There was no significant difference in the incidence of mace and adverse reactions between the two groups (P>0.05). Conclusion Cinepazide Maleate Injection combined with sacubatrovalsartan is effective in the treatment of patients with HFrEF. It can effectively improve exercise endurance and cardiac function, reduce the level of markers of heart failure, reverse ventricular remodeling, and has high safety.

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