目的 評價(jià)托伐普坦聯(lián)合米力農(nóng)治療難治性心力衰竭的療效。方法 選取2018年10月—2020年6月在內(nèi)蒙古包鋼醫(yī)院治療的60例難治性心力衰患者作為研究對象，根據(jù)治療方法將患者分為對照組和觀察組，每組30例。對照組給予米力農(nóng)注射液，0.5 μg/（kg·min）持續(xù)泵入72 h，繼續(xù)以每次泵入4 d，共7 d。觀察組患者在對照組的基礎(chǔ)上口服托伐普坦片，15～30 mg/次，共7 d。觀察患者的臨床療效，同時(shí)比較兩組治療前后的腦鈉肽（BNP）、氨基末端腦鈉肽前體（NT-proBNP）、腎素（PRA）、血管緊張素Ⅱ（AngⅡ）、醛固酮（ALD）、白細(xì)胞介素-6（IL-6）、左室射血分?jǐn)?shù)（LVEF）及左室舒張末徑（LVEDD）、平均肺動脈壓（mPAP）與肺毛細(xì)血管楔壓（PCWC）水平。結(jié)果 治療后，對照組總有效率為73.3%，顯著低于觀察組的90.0%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組LVEF顯著升高，LVEDD值顯著降低（P<0.05）；治療后，觀察組LVEF顯著高于對照組，而LVEDD值顯著低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組mPAP和PCWC水平均明顯下降（P<0.05），且治療后觀察組mPAP和PCWC水平顯著低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組BNP、NT-proBNP、PRA、AngⅡ、ALD和IL-6水平均顯著降低（P<0.05）；且觀察組血清學(xué)指標(biāo)水平顯著低于對照組（P<0.05）。結(jié)論 托伐普坦聯(lián)合米力農(nóng)治療難治性心力衰竭療效顯著，且能改善患者心功能、mPAP和PCWC及相關(guān)血清學(xué)指標(biāo)水平，提高生活質(zhì)量。

Objective To evaluate the efficacy of tolvaptan combined with milrinone in treatment of refractory heart failure. Methods A total of 60 patients with refractory heart failure who were treated in Baogang Hospital of Inner Mongolia from October 2018 to June 2020 were selected as the research subjects. According to the treatment methods, the patients were divided into control group and observation group, with 30 patients in each group. Patients in the control group were given Milrinone Injection, 0.5 μg/(kg·min), continuously pumped for 72 h, and continued for 4 days. Patients in the observation group were po administered with Tolvaptan Tablets on the basis of control group, 15 — 30 mg/time for 7 days. To observe the clinical efficacy of the patients, at the same time, the levels of BNP, NT-proBNP, PRA, AngⅡ, ALD, IL-6, LVEF, LVEDD, mPAP, and PCWC in two groups before and after treatment were compared. Results After treatment, the total effective rate of the control group was 73.3%, which was significantly lower than 90.0% of the observation group, the difference being statistically significant (P < 0.05). After treatment, LVEF in two groups was significantly increased, but LVEDD was decreased (P < 0.05). After treatment, LVEF of the observation group was significantly higher than that of the control group, while LVEDD of the observation group was significantly lower than that of the control group, with statistical significance (P < 0.05). After treatment, the levels of mPAP and PCWC in two groups were significantly decreased (P < 0.05), and the levels of mPAP and PCWC in the observation group were significantly lower than those in the control group after treatment, the difference was statistically significant (P < 0.05). After treatment, the levels of BNP, NTproBNP, PRA, AngⅡ, ALD, and IL-6 in two groups were significantly decreased (P < 0.05). The serological indexes in observation group were significantly lower than those in control group (P < 0.05). Conclusion Torvaptan combined with milrinone has significant efficacy in treatment of refractory heart failure, and can improve the levels of cardiac function, mPAP, PCWC, and related serological indexes and improve the quality of life of patients.