目的 探討參附注射液聯(lián)合磷酸肌酸鈉對擴張型心肌病心力衰竭患者心功能、心率變異性和血清腦利鈉肽（BNP）的影響。方法 選擇2016年8月-2019年2月在陜西省核工業(yè)二一五醫(yī)院心內(nèi)科收治的擴張型心肌病心力衰竭患者122例，根據(jù)隨機數(shù)字表法把患者分為對照組與觀察組，每組各61例。對照組靜脈滴注注射用磷酸肌酸鈉，1 g注射用磷酸肌酸鈉用0.9%氯化鈉注射液溶解后進行靜脈滴注30 min左右，1次/d。觀察組在對照組治療的基礎上給予參附注射液治療，20 mL加入0.9%葡萄糖250 mL進行30 min左右靜脈滴注，1次/d。兩組均治療14 d。記錄兩組患者的心功能指標、心率變異性及BNP的變化情況，比較兩組的心臟不良事件的發(fā)生情況。結果 治療后，兩組左心房內(nèi)徑（LA）值顯著低于治療前（P<0.05），左室射血分數(shù)（LVEF）值顯著高于治療前（P<0.05），且觀察組心功能指標均優(yōu)于對照組（P<0.05）。兩組治療后的PNN50與RMSSD值都顯著高于治療前（P<0.05），且觀察組PNN50與RMSSD值均明顯高于對照組（P<0.05）。兩組治療后的血清BNP值均低于治療前（P<0.05），且觀察組BNP值明顯低于對照組（P<0.05）。觀察組治療后6個月主要心臟不良事件發(fā)生率為4.9%，顯著低于對照組的19.7%（P<0.05）。結論 參附注射液聯(lián)合磷酸肌酸鈉治療擴張型心肌病心力衰竭能改善患者的心功能及心率變異性，抑制BNP的釋放，減少主要心臟不良事件的發(fā)生，具有臨床推廣應用價值。

Objective To investigate the effects of Shenfu Injection combined with creatine phosphate sodium on cardiac function, heart rate variability, and serum BNP in patients with dilated cardiomyopathy with heart failure. Methods Patients (122 cases) with dilated cardiomyopathy and heart failure in the NO.215 Hospital of Shaanxi Nuclear Industry from August 2016 to February 2019 were enrolled, and divided into control group and observation group, each group had 61 cases. Patients in the control group were iv administered with Creatine Phosphate Sodium for Injection, 1 g was dissolved in 0.9% sodium chloride injection, followed by intravenous infusion for 30 min, once daily. Patients in the observation group was treated with Shenfu Injection on the basis of the control group, and 20 mL was added with 0.9% glucose 250 mL for intravenous infusion for 30 min, once daily. Patients in two groups were treated for 14 d. The changes of cardiac function indexes, heart rate variability, and BNP in two groups were recorded, and the occurrence of adverse cardiac events in two groups was compared. Results After treatment, the LA value in two groups after treatment was significantly lower than that before treatment, and the LVEF value was significantly increased (P<0.05), and the cardiac function indexes in the observation group were better than those in the control group (P<0.05). After treatment, PNN50 and RMSSD values in two groups were significantly higher than those before treatment (P<0.05), and PNN50 and RMSSD values in the observation group were significantly higher than those in the control group (P<0.05). After treatment, serum BNP values in two groups were lower than that before treatment (P<0.05), and BNP values in the observation group were significantly lower than those in the control group (P<0.05). The incidence of major adverse cardiac events in the observation group at 6 months after treatment was 4.9%, which was significantly lower than 19.7% in the control group (P<0.05). Conclusion Shenfu Injection combined with creatine phosphate sodium in treatment of heart failure in dilated cardiomyopathy can improve the cardiac function and heart rate variability, inhibit the release of BNP, and reduce the occurrence of major adverse cardiac events, it has clinical application value.

R972

陜西省科技攻關項目2016YFJH2-07