目的 探討復(fù)方丹參滴丸聯(lián)合托伐普坦治療急性心肌梗死并發(fā)心力衰竭的臨床效果。方法 選取2018年3月-2019年8月新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院收治的94例急性心肌梗死并發(fā)心力衰竭患者，隨機分成對照組（47例）和治療組（47例）。對照組口服托伐普坦片，15 mg/次，1次/d。治療組在對照組基礎(chǔ)上口服復(fù)方丹參滴丸，0.27 g/次，3次/d。兩組均治療7 d。觀察兩組患者臨床療效，比較治療前后兩組患者24 h尿量、臨床表現(xiàn)緩解時間，心臟標(biāo)志物心肌肌鈣蛋白I（cTnI）、肌紅蛋白（Myo）、心臟脂肪酸結(jié)合蛋白（H-FABP）、B型利鈉肽（BNP）和半乳糖凝集素-3（Gal-3）水平及超聲心動圖參數(shù)。結(jié)果 治療后，對照組和治療組臨床有效率分別為78.7%、93.6%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，治療組24 h尿量顯著增加（P<0.05），且治療組相關(guān)臨床表現(xiàn)緩解時間則均比對照組顯著縮短（P<0.05）。治療后，兩組患者血清cTnI、Myo、H-FABP、BNP和Gal-3水平顯著低于治療前（P<0.05），且治療組患者比對照組下降更為顯著（P<0.05）。治療后，兩組患者左室射血分?jǐn)?shù)（LVEF）、心排量（CO）均顯著高于治療前（P<0.05），而左心房容積指數(shù)（LAVI）、二尖瓣口舒張早期血流速度峰值與二尖瓣環(huán)舒張早期組織運動速度峰值比值（E/e'）均顯著降低（P<0.05），且治療組這些超聲心動圖參數(shù)顯著優(yōu)于對照組（P<0.05）。結(jié)論 復(fù)方丹參滴丸聯(lián)合托伐普坦能有效縮短急性心肌梗死并發(fā)心力衰竭患者臨床癥狀的持續(xù)時間，減輕心臟損傷，并有助于促進病人心臟結(jié)構(gòu)及功能的恢復(fù)，療效確切，安全可靠。

Objective To investigate the clinical effect of Compound Danshen Dropping Pills combined with tolvaptan in treatment of acute myocardial infarction complicated with heart failure. Methods Patients (94 cases) with acute myocardial infarction complicated with heart failure in the First Affiliated Hospital of Xinxiang Medical University from March 2018 to August 2019 were randomly divided into control (47 cases) and treatment (47 cases) groups. Patients in the control group were po administered with Tolvaptan Tablets, 15 mg/time, once daily. Patients in the treatment group were po administered with Compound Danshen Dropping Pills on the basis of the control group, 0.27 g/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the 24 h urine volume, clinical manifestation time, cardiac markers cTnI, Myo, H-FABP, BNP, and Gal-3 levels, and the echocardiographic parameters in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 78.7% and 93.6%, respectively, and there were differences between two groups (P < 0.05). After treatment, the 24 h urine volume in treatment group was significantly increased (P < 0.05), and the clinical manifestation time in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, the cardiac markers serum concentration of cTnI, Myo, H-FABP, BNP, and Gal-3 in two groups was significantly decreased (P < 0.05), and which in the treatment group was significantly lower than those in the control group (P < 0.05). After treatment, the LVEF and CO levels in two groups were significantly increased (P < 0.05), but LAVI and E/e' were significantly decreased (P < 0.05), and the echocardiographic parameters in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Compound Danshen Dropping Pills combined with Tolvaptan Tablets can effectively shorten the duration of clinical symptoms of acute myocardial infarction complicated with heart failure, reduce heart damage, and promote the recovery of cardiac structure and function, and the clinical effect is exact and safe.

R972

河南省衛(wèi)生和計劃生育委員會科研課題（201605A3049）