目的 探討重組人腦利鈉肽聯(lián)合艾司洛爾治療缺血性心力衰竭的安全性和有效性。方法 選取平煤神馬醫(yī)療集團(tuán)總醫(yī)院2015年10月—2016年10月收治的缺血性心力衰竭患者124例，隨機(jī)分成對(duì)照組和治療組，每組各62例。對(duì)照組患者靜脈注射鹽酸艾司洛爾注射液，首劑量為0.5 mg/kg，然后持續(xù)靜脈泵入，速率為0.05 mg/（kg·min），根據(jù)患者血壓、心率調(diào)整劑量，待臨床癥狀緩解后停止給藥。治療組在對(duì)照組的基礎(chǔ)上靜脈注射凍干重組人腦利鈉肽，首劑量為1.5 μg/kg，然后持續(xù)靜脈泵入，速率為7.5 ng/（kg·min），持續(xù)48 h。兩組患者均連續(xù)治療7 d。比較兩組患者治療前后臨床療效、超聲心動(dòng)圖、心功能預(yù)后和不良反應(yīng)發(fā)生情況。結(jié)果 治療后，對(duì)照組和治療組總有效率分別為72.58%、91.94%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組患者左心室舒張末期內(nèi)徑（LVEDD）、左心室收縮末期內(nèi)徑（LVESD）和左心房舒張期內(nèi)徑（LADD）顯著降低，左心室射血分?jǐn)?shù)（LVEE）明顯升高，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）；且治療組患者上述指標(biāo)改善情況顯著優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組患者N末端心房利鈉肽（NT-proBNP）和內(nèi)皮素-1（ET-1）均明顯下降（P< 0.05）；且治療組NT-proBNP和ET-1水平顯著低于對(duì)照組（P< 0.05）。結(jié)論 重組人腦利鈉肽聯(lián)合艾司洛爾治療缺血性心力衰竭的臨床療效顯著優(yōu)于單用艾司洛爾治療，且安全性較高，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To explore the safety and efficacy of recombinant human brain natriuretic peptide combined with esmolol in treatment of ischemic heart failure. Methods Patients (124 cases) with ischemic heart failure in Pingdingshan Shenma Medical Group General Hospital from October 2015 to October 2016 were randomly divided into control and treatment groups, and each group had 23 cases. Patients in the control group were iv administered with Esmolol Hydrochloride Injection, the first dosage was 0.5 mg/kg, then the continuous intravenous pumping was performed, and the speed was 0.05 mg/(kg·min), adjusted the dose according to the patient's blood pressure and heart rate, and discontinued treatment after clinical symptoms had been relieved. Patients in the treatment group were iv administered with Freeze-dried Recombinant Human Brain Natriuretic Peptide on the basis of the control group, the first dosage was 1.5 μg/kg, then the continuous intravenous pumping was performed, and the speed was 7.5 ng/(kg·min) for 48 h. Patients in two groups were treated for 4 d. After treatment, clinical efficacy, echocardiographic indexes, cardiac function prognosis, and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 72.58% and 91.94%, respectively, and there was difference between two groups (P < 0.05). After treatment, the LVEDD, LVESD, and LADD in two groups significantly decreased, but LVEF obviously increased, and the difference was statistically significant in the same group (P < 0.05). And the improvement of these indexes in the treatment group was significantly better than that in the control group, with significant difference between two groups (P < 0.05). After treatment, the NT-proBNP and ET-1 levels in two groups significantly decreased (P < 0.05). And the NT-proBNP and ET-1 levels in treatment group were significantly lower than those in the control group (P < 0.05). Conclusion The clinical efficacy of recombinant human brain natriuretic peptide combined with esmolol in treatment of ischemic heart failure is significantly better than that of esmolol with high safety, which has a certain clinical application value.