麝香通心滴丸联合“新四联”方案对老年射血分数保留的心力衰竭患者的疗效分析  

Analysis of curative effect of Shexiang Tongxin dropping pills combined with“Quadruple therapy”on elderly patients with heart failure with preserved ejection fraction

作　　者：娄凯 张继琛 郝瑩 李如君 LOU Kai;ZHANG Jichen;HAO Ying;LI Rujun(Department of Emergency,Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China;Department of Cardiothoracic Surgery,Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China;Department of Geriatrics,Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China;Department of Cardiology,Affiliated Hospital of Yangzhou University,Yangzhou 225012,Jiangsu,China)

机构地区：[1]台州市第一人民医院急诊科,浙江台州318020 [2]台州市第一人民医院心胸外科,浙江台州318020 [3]台州市第一人民医院老年科,浙江台州318020 [4]扬州大学附属医院心内科,江苏扬州225012

出　　处：《中国现代医生》2025年第7期54-58,84,共6页China Modern Doctor

基　　金：江苏省自然科学基金(BK20200937);台州市科技计划项目(20ywb65,1902ky59)。

摘　　要：目的评估麝香通心滴丸联合“新四联”方案对老年射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者的临床疗效。方法选取2022年1月至6月扬州大学附属医院收治的老年HFpEF患者193例为研究对象,根据随机数字表法将其分为观察组(97例)和对照组(96例)。对照组患者采用沙库巴曲缬沙坦钠片+达格列净片+酒石酸美托洛尔片+螺内酯片治疗,观察组患者在对照组治疗基础上加用麝香通心滴丸,两组患者均连续治疗6个月。比较两组患者治疗前后的心功能指标、血清心肌损伤标志物、内皮功能及炎症指标变化;统计平均住院天数、30d内再住院率及治疗有效率;随访6个月,比较两组患者的6分钟步行试验、6个月再住院率及主要心血管不良事件(major adverse cardiovascular event,MACE)发生率。结果治疗30d后,观察组患者的总有效率显著高于对照组(93.8%vs.90.6%,χ^(2)=3.982,P=0.031);治疗30d后,观察组患者的左室舒张末期内径、左室收缩末期内径、N末端脑钠肽前体、心肌肌钙蛋白I、核苷酸结合结构域富含亮氨酸重复序列和含热蛋白结构域受体3均显著低于对照组,左室射血分数、二尖瓣舒张早期峰值血流速度(E)/舒张晚期峰值血流速度(A)、一氧化氮均显著高于对照组,6min步行距离显著长于对照组(P<0.05)。随访6个月,观察组患者的平均住院日显著少于对照组,30d再住院率显著低于对照组(P<0.05),两组患者的6个月再住院率和MACE发生率比较差异均无统计学意义(P>0.05)。结论麝香通心滴丸可抑制心脏炎症反应,联合“新四联”方案治疗老年HFpEF患者的临床疗效优于单纯西药治疗,值得临床推广应用。Objective To evaluate the clinical efficacy of Shexiang Tongxin dropping pills combined with“Quadruple therapy”in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 193 elderly HFpEF patients admitted to Affiliated Hospital of Yangzhou University from January to June 2022 were selected as study objects,and were divided into observation group(97 cases)and control group(96 cases)according to random number table method.The control group was treated with sacubitril valsartan sodium tablets+dapagliflozin tablets+metoprolol tartrate tablets+spironolactone tablets,and the observation group was treated with Shexiang Tongxin dropping pills on the basis of control group treatment,and both groups were treated for 6 months.The changes of cardiac function indexes,serum myocardial injury markers,endothelial function and inflammation indexes before and after treatment were compared between two groups.The average length of hospitalization,readmission rate within 30 days and the effective rate of treatment were analyzed.After 6 months of follow-up,the 6-minute walk test,6-month readmission rate and the incidence of major adverse cardiovascular event(MACE)were compared between two groups.Results After 30 days of treatment,the total effective rate of observation group was significantly higher than that of control group(93.8%vs.90.6%,χ^(2)=3.982,P=0.031).After 30 days of treatment,left ventricular end diastolic diameter,left ventricular end systolic diameter,N-terminal pro-brain natriuretic peptide,cardiac troponin I,nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 in observation group were significantly lower than those in control group,left ventricular ejection fraction,early peak mitral valve diastolic blood flow velocity(E)/advanced peak mitral valve diastolic blood flow velocity(A)and nitric oxide were significantly higher than those in control group,and 6 min walking distance was significantly longer than that in control group(P<0.05).After 6

关 键 词：射血分数保留的心力衰竭 老年人 麝香通心滴丸 “新四联”方案 

分 类 号：R541.6[医药卫生—心血管疾病] R256.2[医药卫生—内科学]