目的 探討凍干重組人腦利鈉肽聯(lián)合福辛普利鈉片治療頑固性心力衰竭的臨床療效。方法 選擇2018年10月—2019年11月在天津市第四中心醫(yī)院治療的74例頑固性心力衰竭患者，采用隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各37例。對(duì)照組口服福辛普利鈉片，初次給予10 mg，1次/d，若耐受，可逐漸增至40 mg，1次/d。治療組在對(duì)照組基礎(chǔ)上靜脈給予凍干重組人腦利鈉肽，初始劑量1.5μg/kg靜脈推注3～5 min，然后以0.007 5 μg/（kg·min）靜脈滴注。兩組患者經(jīng)7 d治療。觀察兩組患者臨床療效，比較治療前后兩組患者心功能指標(biāo)每搏輸出量（SV）、心臟指數(shù)（CI）、左室射血分?jǐn)?shù)（LVEF）、左室舒張末期內(nèi)徑（LVEDD），及血清心肌型肌酸激酶同工酶（CK-MB）、氨基末端腦鈉肽前體（NT-proBNP）、內(nèi)皮素-1（ET-1）、半乳糖凝集素-3（Gal-3）、肌鈣蛋白T（cTnT）和Ⅲ型前膠原端肽（PⅢNP）水平。結(jié)果 治療后，對(duì)照組總有效率為70.27%，顯著低于治療組的89.19%（P<0.05）。治療后，兩組患者SV、CI和LVEF顯著升高，而LVEDD顯著降低（P<0.05），且治療組心功能指標(biāo)明顯好于對(duì)照組（P<0.05）。治療后，兩組血清NT-proBNP、Gal-3、cTnT、PⅢNP、ET-1和CK-MB水平均顯著降低（P<0.05），且治療組降低最明顯（P<0.05）。結(jié)論 凍干重組人腦利鈉肽聯(lián)合福辛普利鈉片治療頑固性心力衰竭可有效改善患者心功能，促進(jìn)心肌酶學(xué)指標(biāo)和心肌損傷指標(biāo)的下降，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical efficacy of Lyophilized Recombinant Human Brain Natriuretic Peptide combined with fosinopril sodium in treatment of refractory heart failure. Methods Patients (74 cases) with refractory heart failure in Tianjin 4th Central Hospital from October 2018 to November 2019 were randomly divided into control and treatment groups by random number table method, and each group had 37 cases. Patients in the control group were po administered with Fosinopril Sodium Tablets, the initial dose was 10 mg/d, once daily, and could gradually increased to 40 mg if patients were tolerant. Patients in the treatment group iv administered with Lyophilized Recombinant Human Brain Natriuretic Peptide on the basis of the control group, the initial intravenous injection dose was 1.5 μg/kg for 3 to 5 minutes, then intravenously dripped with 0.007 5 μg/(kg·min). Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the cardiac function indexes of SV, CI, LVEF and LVEDD, and the serum levels of NT-proBNP, Gal-3, cTnT, PⅢNP, ET-1 and CK-MB in two groups before and after treatment were compared. Results After treatment, the clinical effective rate in the control group was 70.27%, which was significantly lower than 89.19% in the treatment group (P<0.05). After treatment, SV, CI and LVEF in two groups were significantly increased, while LVEDD were significantly decreased (P<0.05), and the cardiac function indexes in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the serum levels of NT-proBNP, Gal-3, cTnT, PIII NP, ET-1, and CK-MB were significantly decreased in two groups (P<0.05), especially in the treatment group (P<0.05). Conclusion Lyophilized Recombinant Human Brain Natriuretic Peptide combined with fosinopril sodium in treatment of refractory heart failure can effectively improve the cardiac function and promote the decrease of myocardial enzyme index and myocardial injury index, which has a certain clinical application value.

R972