目的 探究燈盞生脈膠囊聯(lián)合伊伐布雷定治療慢性心力衰竭的臨床療效。方法 選取2020年6月—2022年6月上海市浦東醫(yī)院收治的200例慢性心力衰竭患者，按單雙號將所有患者分為對照組和治療組，每組各100例。對照組于進(jìn)餐時口服鹽酸伊伐布雷定片，5 mg/次，2次/d。治療組在對照組治療基礎(chǔ)上口服燈盞生脈膠囊，2粒/次，3次/d。兩組均持續(xù)治療2個月。觀察兩組的臨床療效、臨床癥狀得分、NYHA心功能分級、心肌重塑指標(biāo)水平、血清學(xué)及血清炎癥指標(biāo)、明尼蘇達(dá)生活質(zhì)量（LiHFe）評分及6分鐘步行試驗（6MWT）。結(jié)果 治療后，治療組總有效率是94.00%，顯著高于對照組的85.00%（P＜0.05）。治療后，治療組患者臨床癥狀得分、NYHA分級得分、左室舒張末期內(nèi)徑（LVEDd）和左室收縮末期內(nèi)徑（LVESd）水平均顯著低于同組治療前（P＜0.05）；且治療后，治療組臨床癥狀得分、心功能、心肌重塑指標(biāo)顯著低于對照組（P＜0.05）。治療后，兩組全血高切黏度（HBV）、全血低切黏度（LBV）、血漿黏度（PV）、纖維蛋白原（FIB）明顯降低，而氧合指數(shù)（pO₂/FiO₂）明顯升高（P＜0.05）；治療后，治療組HBV、LBV、PV、FIB低于對照組，pO₂/FiO₂明顯高于對照組（P＜0.05）。治療后，兩組高靈敏度肌鈣蛋白（hs-cTnT）、氨基端前心鈉肽（NT-proBNP）、血清腦鈉肽（BNP）水平均較同組治療前顯著降低（P＜0.05）；且治療后，治療組血清學(xué)指標(biāo)低于對照組（P＜0.05）。治療后，兩組超敏C反應(yīng)蛋白（hs-CRP）、白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）均較同組治療前顯著降低（P＜0.05）；且治療后，治療組炎癥指標(biāo)水平顯著低于對照組（P＜0.05）。治療后，兩組組患者LiHFe評分均顯著降低，而6MWT顯著增加（P＜0.05）；且治療后，治療組LiHFe評分低于對照組，6MWT高于對照組（P＜0.05）。結(jié)論 燈盞生脈膠囊聯(lián)合伊伐布雷定治療慢性心力衰竭有良好的效果，不僅能促進(jìn)心肌重塑，改善心肌能量代謝，并且改善血流動力學(xué)、流變學(xué)、血清學(xué)指標(biāo)，并且能夠降低機(jī)體炎癥水平，降低LiHFe評分，增加6MWT距離。

Objective To explore the clinical efficacy of Dengzhan Shengmai Capsules combined with ivabradine in treatment of chronic heart failure. Methods A total of 200 patients with chronic heart failure admitted to Shanghai Pudong Hospital from June 2020 to June 2022 were selected and divided into control group and treatment group according to odd-even numbers, with 100 patients in each group. Patients in the control group were po administered with Ivabradine Hydrochloride Tablets at meal time, 5 mg/time, twice daily. Patients in the treatment group were po administered with Dengzhan Shengmai Capsules on the basis of the control group, 2 capsules/time, 3 times daily. Both groups were treated for 2 months. After treatment, clinical efficacy, clinical symptom score, NYHA cardiac function grade, myocardial remodeling indexer, serological and serum inflammation index, Minnesota Quality of Life (LiHFe) score and 6-minute walking test (6MWT) were observed in two groups. Results After treatment, the total effective rate of the treatment group was 94.00%, which was significantly higher than that of the control group 85.00% (P < 0.05). After treatment, the clinical symptom score, NYHA grade score, left ventricular end-diastolic diameter (LVEDd) and left ventricular end-systolic diameter (LVESd) levels in treatment group were significantly lower than before treatment (P < 0.05). After treatment, the clinical symptom score, cardiac function and myocardial remodeling indexes in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, whole blood high shear viscosity (HBV), whole blood low shear viscosity (LBV), plasma viscosity (PV) and fibrinogen (FIB) were significantly decreased in both groups, while oxygenation index (pO₂/FiO₂) was significantly increased (P < 0.05). After treatment, HBV, LBV, PV and FIB in the treatment group were lower than those in the control group, and pO₂/FiO₂ was significantly higher than that in the control group (P < 0.05). After treatment, the levels of high-sensitivity troponin (hs-cTnT), amino-terminal procardiac natriuretic peptide (NT-proBNP) and serum brain natriuretic peptide (BNP) in 2 groups were significantly decreased compared with those before treatment (P < 0.05). After treatment, serological indexes in the treatment group were lower than those in the control group (P < 0.05). After treatment, hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were significantly decreased in 2 groups compared with before treatment (P < 0.05). After treatment, the level of inflammation index in the treatment group was significantly lower than that in the control group (P < 0.05). After treatment, LiHFe score was significantly decreased in both groups, while 6MWT was significantly increased (P < 0.05). After treatment, LiHFe score in the treatment group was lower than that in the control group, and 6MWT score was higher than that in the control group (P < 0.05). Conclusion Dengzhan Shengmai Capsules combined with ivabradine has a good effect in treatment of chronic heart failure, can not only promote myocardial remodeling, improve myocardial energy metabolism, improve hemodynamics, rheology and serological indexes, but also reduce the level of inflammation in the body, reduce the LiHFe score and increase the distance of 6MWT.

R972

上海市浦東新區(qū)衛(wèi)生健康委員會衛(wèi)生科技項目（PW2022A-69）