目的 探討奧美沙坦酯聯(lián)合左西孟旦治療老年難治性心力衰竭患者的臨床療效。方法 選取2022年8月—2024年9月滄州市中心醫(yī)院收治的86例難治性心力衰竭患者，依據(jù)隨機(jī)數(shù)字法將患者分為對(duì)照組和治療組，每組43例。對(duì)照組患者靜脈滴注左西孟旦注射液，12.5 mg加入0.9%氯化鈉注射液200 mL稀釋，1次/d。治療組在對(duì)照組的治療基礎(chǔ)上口服奧美沙坦酯片，20 mg/次，1次/d。兩組用藥14 d。觀察臨床療效和臨床癥狀緩解時(shí)間，比較兩組患者治療前后6 min步行試驗(yàn)距離（6MWT）、簡明健康狀況調(diào)查量表（SF-36）評(píng)分、心功能相關(guān)指標(biāo)、心肌損傷因子及炎性因子水平的變化情況。結(jié)果 治療14 d后，治療組總有效率是95.35%，顯著高于對(duì)照組的79.07%（P＜0.05）。治療14 d后，與對(duì)照組對(duì)比，治療組氣急、疲乏、發(fā)紺、四肢發(fā)冷緩解時(shí)間均較短（P＜0.05）。治療后，兩組6MWT、ST-36評(píng)分均顯著增加（P＜0.05）；治療后，與對(duì)照組對(duì)比，治療組6MWT、ST-36評(píng)分均較高（P＜0.05）。治療后，兩組患者左心室收縮末期內(nèi)徑（LVESD）、左心室舒張末期內(nèi)徑（LVEDD）較治療前顯著降低，而左心室射血分?jǐn)?shù)（LVEF）升高（P＜0.05）；治療后，與對(duì)照組對(duì)比，治療組LVESD、LVEDD指標(biāo)均較低，LVEF較高（P＜0.05）。治療后，兩組患者長正五聚蛋白-3（PTX-3）、半乳糖凝集素3（galectin-3）、氨基末端腦利鈉肽前體（NT-proBNP）、心肌型脂肪酸結(jié)合蛋白（H-FABP）水平均較治療前降低（P＜0.05）；治療后，與對(duì)照組對(duì)比，治療組PTX-3、galectin-3、NT-proBNP、H-FABP水平均較低（P＜0.05）。治療后，兩組轉(zhuǎn)化生長因子β1（TGF-β1）、脂蛋白（a）[LP（a）]、腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素-23（IL-23）水平均顯著降低（P＜0.05）；治療后，與對(duì)照組對(duì)比，治療組TGF-β1、LP（a）、TNF-α、IL-23水平均較低（P＜0.05）。結(jié)論 奧美沙坦酯聯(lián)合左西孟旦治療難治性心力衰竭效果明顯，能有效改善心功能相關(guān)指標(biāo)，降低機(jī)體炎癥反應(yīng)，改善心肌損傷狀態(tài)，顯著提升患者生活質(zhì)量，值得借鑒與推廣。

Objective To investigate the therapeutic effect of olmesartan medoxomil combined with levosimendan in treatment of elderly refractory heart failure. Methods A total of 86 patients with refractory heart failure admitted to Cangzhou Central Hospital from August 2022 to September 2024 were selected and divided into control group and treatment group according to random number method, with 43 cases in each group. Patients in control group were iv administered with Levosimendan Injection, 12.5 mg was diluted with 0.9% sodium chloride injection 200 mL, once daily. Patients in treatment group were po administered with Olmesartan Medoxomil Tablets on the basis of the control group, 20 mg/time, once daily. Both groups were treated for 14 d. The clinical efficacy and the duration of clinical symptom remission were observed, and the changes of 6MWT, SF-36 score, cardiac function related indexes, myocardial injury factors and inflammatory factors before and after treatment were compared between two groups. Results After 14 d of treatment, the total effective rate of the treatment group was 95.35%, which was significantly higher than that of the control group (79.07%, P < 0.05). After 14 d of treatment, the relief time of dyspnea, fatigue, cyanosis and cold limbs in treatment group was shorter than that in control group (P < 0.05). After treatment, 6MWT and ST-36 scores were significantly increased in both groups (P < 0.05). After treatment, 6MWT and ST-36 scores in treatment group were higher than those in control group (P < 0.05). After treatment, LVESD and LVEDD in 2 groups were significantly lower than before treatment, but LVEF was increased (P < 0.05). After treatment, compared with the control group, LVESD and LVEDD indexes in treatment group were lower, but LVEF was higher (P < 0.05). After treatment, the levels of PTX-3, galectin-3, NT-proBNP, and H-FABP in 2 groups were decreased compared with those before treatment (P < 0.05). After treatment, the levels of PTX-3, galectin-3, NT-proBNP and H-FABP in treatment group were lower than those in control group (P < 0.05). After treatment, the levels of TGF-β1, LP (a), TNF-α, and IL-23 were significantly decreased in both groups (P < 0.05). After treatment, the levels of TGF-β1, LP (a), TNF-α and IL-23 in treatment group were lower than those in control group (P < 0.05). Conclusion Olmesartan medoxomil combined with levosimendan has obvious effect in treatment of elderly refractory heart failure, and can effectively improve the related indicators of heart function, reduce the inflammatory response of the body, improve the state of myocardial injury, and significantly improve the quality of life of patients, which is worth learning and promoting.

R972

河北省醫(yī)學(xué)科學(xué)研究重點(diǎn)課題計(jì)劃項(xiàng)目（20220416）；滄州市重點(diǎn)研發(fā)課題項(xiàng)目計(jì)劃（213106015）