目的 研究沙庫(kù)巴曲纈沙坦鈉片聯(lián)合鹽酸曲美他嗪片治療缺血性心肌病的療效以及對(duì)血清內(nèi)皮素-1（ET-1）、N末端鈉尿肽前體（NT-proBNP）水平的影響。方法 選取2019年8月—2020年12月邢臺(tái)市第三醫(yī)院收治的148例缺血性心肌病患者為研究對(duì)象，根據(jù)治療方法將患者分為對(duì)照組和觀察組，每組各74例。對(duì)照組服用鹽酸曲美他嗪片，1片/次，3次/d。觀察組患者在對(duì)照組基礎(chǔ)上服用沙庫(kù)巴曲纈沙坦鈉片，初始劑量為50 mg，2次/d，若患者可耐受則提高至200 mg，2次/d。兩組患者均治療4周。觀察兩組患者的臨床療效，同時(shí)比較兩組治療前后的心功能指標(biāo)、血清ET-1、NT-pro BNP水平、6分鐘步行距離（6 MWT）、日常生活活動(dòng)能力（ADL）評(píng)分。結(jié)果 治療后，觀察組總有效率為93.24%，顯著高于對(duì)照組的82.43%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，左室射血分?jǐn)?shù)（LVEF）明顯增加，左心室收縮末期容積（LVESV）、左心室舒張末期容積（LVEDV）明顯降低（P<0.05），且觀察組心功能指標(biāo)改善情況顯著優(yōu)于對(duì)照組（P<0.05）。治療后，血清ET-1、NT-pro BNP水平均明顯降低（P<0.05），其中觀察組血清ET-1、NT-pro BNP水平顯著低于對(duì)照組（P<0.05）。治療后，ADL評(píng)分和6 MWT均明顯增加（P<0.05），且觀察組ADL評(píng)分和6 MWT顯著高于對(duì)照組（P<0.05）。結(jié)論 沙庫(kù)巴曲纈沙坦鈉片聯(lián)合曲美他嗪治療對(duì)缺血性心肌病療效顯著，可有效降低血清ET-1、NT-pro BNP水平，降低心肌損傷，利于疾病恢復(fù)，提高患者日常生活能力，值得臨床推廣。

Objective To study the curative effect of Sacubitril Valsartan Sodium Tablets combined with Trimetazidine Dihydrochloride Tablets in treatment of ischemic cardiomyopathy and its effect on serum ET-1 and NT-proBNP. Methods A total of 148 patients with ischemic cardiomyopathy admitted to the Xingtai Third Hospital from August 2019 to December 2020 were selected as the research subjects. According to the treatment methods, the patients were divided into control group and observation group, with 74 patients in each group. Patients in the control group were po administered with Trimetazidine Dihydrochloride Tablets, 1 table/time, three times daily. Patients in the observation group were po administered with Sacubitril Valsartan Sodium Tablets on the basis of control group, the initial dose was 50 mg, twice daily, and the dose was increased to 200 mg twice daily if patients could tolerate it. Patients in both groups were treated for 4 weeks. Clinical efficacy of two groups was observed. Cardiac function indexes, serum ET-1, NT-Pro BNP levels, 6-minute walking test (6 MWT), and activity of daily living (ADL) before and after treatment were compared between two groups. Results After treatment, the total effective rate of the observation group was 93.24%, significantly higher than 82.43% of the control group, and the difference was statistically significant (P < 0.05). After treatment, LVEF was significantly increased, LVESV and LVEDV were significantly decreased (P < 0.05), and the improvement of heart function indexes in the observation group was significantly better than that in the control group (P < 0.05). After treatment, serum ET-1 and NT-pro BNP levels were significantly decreased (P < 0.05), and the serum ET-1 and NT-pro BNP levels in the observation group were significantly lower than those in the control group (P < 0.05). After treatment, ADL score and 6 MWT were significantly increased (P < 0.05), and the ADL score and 6 MWT in observation group were significantly higher than those in control group (P < 0.05). Conclusion Sacubitril Valsartan Sodium Tablets combined with trimetazidine has a significant effect on ischemic cardiomyopathy, which can effectively reduce serum ET-1 and NT-Pro BNP levels, reduce myocardial injury, benefit disease recovery and improve patients' ability of daily life, and is worthy of clinical promotion.

R972

邢臺(tái)市重點(diǎn)研發(fā)計(jì)劃項(xiàng)目（2020ZC268）