目的 探討穩(wěn)心顆粒聯(lián)合硝酸甘油治療急性左心衰竭的臨床效果。方法 選取2018年2月—2021年8月國藥葛洲壩中心醫(yī)院收治的136例急性左心衰竭患者，按隨機數(shù)字表法將136例患者分成對照組和治療組，每組各68例。對照組給予微量泵持續(xù)泵入硝酸甘油注射液，泵入速率為5μg/min。治療組在對照組基礎(chǔ)上開水沖服穩(wěn)心顆粒，1袋/次，3次/d。兩組均連續(xù)治療7d。觀察兩組的臨床療效河典型表現(xiàn)的緩解時間。比較治療前后兩組血漿心肌損傷標(biāo)志物[心肌肌鈣蛋白（cTn）I、cTnT、肌酸激酶同工酶（CK-MB）、N末端B型利鈉肽原（NT-proBNP）]水平、超聲心動圖參數(shù)[左室射血分?jǐn)?shù)（LVEF）、心博量（SV）、左房容量指數(shù)（LAVI）、二尖瓣舒張期血流E峰與A峰比值（E/A）]及血清白細(xì)胞介素（IL）-1β、可溶性腫瘤生成抑制因子2（sST2）、基質(zhì)金屬蛋白酶9（MMP-9）和內(nèi)皮素-1（ET-1）水平。結(jié)果 治療后，治療組總有效率是95.6%，顯著高于對照組的82.4%（P<0.05）。治療后，治療組呼吸困難、肺部啰音、下肢水腫的緩解時間均顯著短于對照組（P<0.05）。治療后，兩組血漿cTnI、cTnT、CK-MB和NT-proBNP水平均顯著下降（P<0.05）；且均以治療組降低更顯著（P<0.05）。治療后，兩組LVEF、SV、E/A均顯著增加，LAVI均顯著降低（P<0.05）；且均以治療組的改善更顯著（P<0.05）。治療后，兩組血清IL-1β、sST2、MMP-9和ET-1水平均顯著低于治療前（P<0.05）；且治療后，治療組血清IL-1β、sST2、MMP-9及ET-1水平低于對照組（P<0.05）。結(jié)論 穩(wěn)心顆粒聯(lián)合硝酸甘油對急性左心衰竭患者具有確切的臨床療效，可安全有效且迅速地緩解患者臨床表現(xiàn)、減輕心肌損傷、改善左心室收縮和舒張功能，并能進一步抑制患者血中IL-1β、sST2、MMP-9和ET-1水平。

Objective To investigate the clinical effect of Wenxin Granules combined with nitroglycerin in treatment of acute left heart failure. Methods A total of 136 patients with acute left heart failure admitted to Sinopharm Gezhouba Central Hospital from February 2018 to August 2021 were selected and divided into control group and treatment group according to the random number table method, with 68 cases in each group. The control group was continuously pumped with Nitroglycerin Injection at a rate of 5 μg/min. Patients in the treatment group were po administered with Wenxin Granules on the basis of the control group, 1 bag/time, 3 times daily. Both groups were treated for 7 d. The clinical efficacy of the two groups was observed and the typical remission time was observed. The levels of plasma myocardial injury markers [cardiac troponin (cTn) I, cTnT, creatine kinase isoenzyme (CK-MB), N-terminal pro-B-type natriuretic peptide (NT-proBNP)], Echocardiographic parameters [left ventricular ejection fraction (LVEF), stroke volume (SV), left atrial volume index (LAVI), mitral diastolic blood flow E-peak to A-peak ratio (E/A)] and serum Interleukin (IL)-1β, soluble tumor suppressor factor 2 (sST2), matrix metalloproteinase 9 (MMP-9) and endothelin-1 (ET-1) levels in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was 95.6%, which was significantly higher than 82.4% of the control group (P< 0.05). After treatment, the remission time of dyspnea, pulmonary rales and lower limb edema in the treatment group were significantly shorter than those in the control group (P < 0.05). After treatment, the plasma levels of cTnI, cTnT, CK-MB and NT-probNP in the two groups were significantly decreased (P < 0.05). And the reduction was more significant in the treatment group (P < 0.05). After treatment, LVEF, SV and E/A were significantly increased, and LAVI was significantly decreased in both groups (P< 0.05). The improvement in treatment group was more significant (P< 0.05). After treatment, the serum levels of IL-1β, sST2, MMP-9 and ET-1 in the two groups were significantly lower than those before treatment (P< 0.05). After treatment, the serum levels of IL-1β, sST2, MMP-9 and ET-1 in the treatment group were lower than those in the control group (P < 0.05). Conclusion Wenxin Granules combined with nitroglycerin has a definite clinical effect on patients with acute left heart failure. It can safely, effectively and rapidly relieve the clinical manifestations, reduce myocardial damage, improve left ventricular systolic and diastolic function, and further inhibit the blood levels of IL-1β, sST2, MMP-9 and ET-1.

R972

三峽大學(xué)青年科學(xué)基金（KJ2019A009）