目的：探讨沙库巴曲缬沙坦钠对慢性心力衰竭（CHF）患者心电稳定性及心脏负荷的改善作用。方法：病例纳入2023年10月~2025年5月收治的102例CHF患者为研究对象，依据就诊时间段及治疗方案不同，将2023年3月~2024年6月沿用缬沙坦+螺内酯+比索洛尔治疗的51例患者列为常规组，将2024年7月~2025年9月采用沙库巴曲缬沙坦+螺内酯+比索洛尔治疗的51例患者列为试验组，比较两组患者的心肌纤维化，心电稳定性，心脏负荷及治疗安全性。所有患者均接受为期半年随访，比较两组患者的预后情况。结果：治疗后，试验组的基质金属蛋白酶-2（MMP-2）、基质金属蛋白酶-9（MMP-9）、半乳糖凝集素-3（Gal-3）、可溶性生长刺激表达基因2蛋白（sST2）均低于常规组（t=5.045，2.889，4.115，4.582；P＜0.05）。试验组的校正QT间期（QTc）、QT离散度（QTd）、T波峰-末间期（Tp-e）、室性早搏次数分别为（405.39±40.26）ms、（45.25±5.33）ms、（90.33±5.28）ms、（80.36±5.39）次/24h，均低于常规组[（450.22±42.19）ms、（50.37±6.15）ms、（95.29±6.44）ms、（85.27±6.18）次/24h]（t=5.490，4.493，4.253，4.276；P＜0.05）。试验组的收缩期肺动脉压（sPAP）、三尖瓣反流峰值速度（TRVmax）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）分别为（20.48±5.26）mmHg、（2.13±0.25）m/s、（45.29±5.62）mm、（30.61±5.33）mm，均低于常规组[（25.35±6.29）mmHg、（3.22±0.47）m/s、（50.45±6.15）mm、（35.49±6.27）mm]（t=4.242，14.622，4.423，4.235；P＜0.05）。试验组的药物相关副反应发生率与常规组比较，差异无统计学意义（P＞0.05）。截至随访结束时，试验组的不良预后发生率9.80%（5/51）低于常规组27.45%（14/51）（x2=5.239；P＜0.05）。结论：沙库巴曲缬沙坦钠能延缓CHF患者的心肌纤维化进程并改善心电稳定性，在有效改善心电稳定性并降低不良预后发生风险同时未显著增加治疗风险。

Objective:To explore the improvement effect of sacubitril valsartan sodium on electrocardiogram stability and cardiac load in patients with CHF.Methods:A total of 102 CHF patients admitted from October 2023 to May 2025 were included in the study. Based on the treatment period and regimen, 51 patients treated with valsartan, spironolactone, and bisoprolol from March 2023 to June 2024 were classified as the conventional group, while 51 patients treated with sacubitril/valsartan, spironolactone, and bisoprolol from July 2024 to September 2025 were designated as the experimental group. The myocardial fibrosis, electrocardiographic stability, cardiac workload, and treatment safety were compared between the two groups. All patients underwent a six-month follow-up to assess their prognosis.Results:After treatment, the levels of MMP-2, MMP-9, Gal-3, and sST2 in the experimental group were lower than the control group (t=5.045，2.889，4.115，4.582; P<0.05). The QTc, QTd, Tp-e, and number of ventricular premature beats in the experimental group were (405.39 ± 40.26) ms, (45.25 ± 5.33) ms, (90.33 ± 5.28) ms, and (80.36 ± 5.39) beats per 24 hours, lower than the control group [(450.22 ± 42.19) ms, (50.37 ± 6.15) ms, (95.29 ± 6.44) ms, and (85.27 ± 6.18) beats per 24 hours] (t=5.490，4.493，4.253，4.276; P<0.05). The sPAP, TRVmax, LVEDD, and LVESD of the experimental group were (20.48 ± 5.26) mmHg, (2.13 ± 0.25) m/s, (45.29 ± 5.62) mm, and (30.61 ± 5.33) mm, lower than the conventional group [(25.35 ± 6.29) mmHg, (3.22 ± 0.47) m/s, (50.45 ± 6.15) mm, and (35.49 ± 6.27) mm] (t=4.242，14.622，4.423，4.235; P<0.05). The incidence of drug-related side effects in the experimental group was not significantly different from that in the control group (P>0.05). As of the end of follow-up, the incidence of poor prognosis in the experimental group was 9.80% (5/51) lower than that in the conventional group 27.45% (14/51) (x2=5.239; P<0.05).Conclusion:Sacubitril valsartan sodium can delay the progression of myocardial fibrosis and improve electrocardiogram stability in CHF patients, effectively improving electrocardiogram stability and reducing the risk of adverse prognosis without significantly increasing treatment risk.

目的 探讨活血通络汤联合恩格列净治疗射血分数降低型心力衰竭（HFrEF）患者的疗效，并分析其对中医证候积分、心功能的影响。方法 选取2024年8月～2025年8月于本院诊治的150例HFrEF患者进行回顾性分析，依据治疗方案不同将其分为对照组、观察组，其中采取恩格列净治疗的75例患者作为对照组，采取活血通络汤联合恩格列净治疗的75例患者作为观察组。统计对比两组临床疗效及治疗前后中医证候积分、Lee氏心衰积分、心功能、6 min步行试验（6MWT）、心衰因子[心肌肌钙蛋白I（cTnI）、可溶性人基质裂解素2（sST2）、N末端B型利钠肽原（NT-proBNP）]、血流动力学、炎症因子[白细胞介素-6（IL-6）、C反应蛋白（CRP）、白细胞介素-1β（IL-1β）、正五聚蛋白-3（PTX-3）]、氧化应激指标[谷胱甘肽过氧化物酶-3（GPX-3）、丙二醛（MDA）、超氧化物歧化酶（SOD）、脂质过氧化物（LPO）、总抗氧化能力]。比较两组不良反应与再住院率。结果 观察组总有效率高于对照组（P＜0.05）；观察组治疗后中医证候积分、Lee氏心衰积分低于对照组（P＜0.05）；观察组治疗后LVEDD、LVESD、LVEDV、LVESV及血清cTnI、sST2、NT-proBNP水平低于对照组，LVEF、6MWT高于对照组（P＜0.05）；观察组治疗后血流动力学改善程度优于对照组（P＜0.05）；治疗后，与对照组比较，观察组血清IL-6、CRP、IL-1β、PTX-3、MDA、LPO水平降低，GPX-3、SOD、总抗氧化能力水平升高（P＜0.05）；观察组再住院率低于对照组（P＜0.05），且两组不良反应比较无明显差异（P＞0.05）。结论 活血通络汤联合恩格列净治疗HFrEF患者，可提高治疗效果，改善临床症状、心功能，调节血流动力学，并可降低炎症反应，抑制氧化应激反应，减少再住院的发生，且具有一定安全性。

Objective To explore the therapeutic effect of Huoxue Tongluo Decoction combined with empagliflozin on patients with heart failure with reduced ejection fraction (HFrEF), and analyze its influence on traditional Chinese medicine syndrome scores and cardiac function. Methods A retrospective analysis was performed on 150 HFrEF patients treated in our hospital from August 2024 to August 2025. The patients were divided into control group and observation group according to different treatment regimens, 75 patients receiving empagliflozin alone constituted the control group, while another 75 cases treated with combined Huoxue Tongluo Decoction and empagliflozin were assigned to the observation group. The clinical efficacy, as well as the traditional Chinese medicine syndrome scores, Lee heart failure score, cardiac function 6-minute walk test (6MWT), heart failure factors [cardiac troponin I (cTnI), soluble suppression of tumorigenicity 2 (sST2) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)], hemodynamic parameters, inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-1β (IL-1β) and pentraxin-3 (PTX-3)], oxidative stress indexes [glutathione peroxidase-3 (GPX-3), malondialdehyde (MDA), superoxide dismutase (SOD), lipid peroxide (LPO) and total antioxidant capacity] before and after treatment were compared between the two groups. Adverse reactions and readmission rate were also compared. Results The total effective rate of observation group was higher than that of control group (P<0.05). After treatment, traditional Chinese medicine syndrome scores and Lee heart failure score in observation group were lower (P<0.05). LVEDD, LVESD, LVEDV, LVESD and serum levels of cTnI, sST2, NT-proBNP decreased, while LVEF and 6MWT increased in observation group (P<0.05). The improvement of hemodynamics in observation group was superior to control group after treatment (P<0.05). After treatment, serum levels of IL-6, CRP, IL-1β, PTX-3, MDA and LPO were decreased, while GPX-3, SOD and total antioxidant capacity were increased in observation group compared with control group (P<0.05). The readmission rate was lower in observation group (P<0.05). No significant difference was found in adverse reactions between the two groups (P>0.05). Conclusion Huoxue Tongluo Decoction combined with empagliflozin can elevate therapeutic efficacy, relieve clinical symptoms, improve cardiac function and hemodynamic status, reduce inflammatory and oxidative stress responses, and cut down readmission incidence with favorable safety in HFrEF patients.

目的 探讨活血通络汤联合恩格列净治疗射血分数降低型心力衰竭（HFrEF）患者的疗效，并分析其对中医证候积分、心功能的影响。方法 选取2024年8月～2025年8月于本院诊治的150例HFrEF患者进行回顾性分析，依据治疗方案不同将其分为对照组、观察组，其中采取恩格列净治疗的75例患者作为对照组，采取活血通络汤联合恩格列净治疗的75例患者作为观察组。统计对比两组临床疗效及治疗前后中医证候积分、Lee氏心衰积分、心功能、6 min步行试验（6MWT）、心衰因子[心肌肌钙蛋白I（cTnI）、可溶性人基质裂解素2（sST2）、N末端B型利钠肽原（NT-proBNP）]、血流动力学、炎症因子[白细胞介素-6（IL-6）、C反应蛋白（CRP）、白细胞介素-1β（IL-1β）、正五聚蛋白-3（PTX-3）]、氧化应激指标[谷胱甘肽过氧化物酶-3（GPX-3）、丙二醛（MDA）、超氧化物歧化酶（SOD）、脂质过氧化物（LPO）、总抗氧化能力]。比较两组不良反应与再住院率。结果 观察组总有效率高于对照组（P＜0.05）；观察组治疗后中医证候积分、Lee氏心衰积分低于对照组（P＜0.05）；观察组治疗后LVEDD、LVESD、LVEDV、LVESV及血清cTnI、sST2、NT-proBNP水平低于对照组，LVEF、6MWT高于对照组（P＜0.05）；观察组治疗后血流动力学改善程度优于对照组（P＜0.05）；治疗后，与对照组比较，观察组血清IL-6、CRP、IL-1β、PTX-3、MDA、LPO水平降低，GPX-3、SOD、总抗氧化能力水平升高（P＜0.05）；观察组再住院率低于对照组（P＜0.05），且两组不良反应比较无明显差异（P＞0.05）。结论 活血通络汤联合恩格列净治疗HFrEF患者，可提高治疗效果，改善临床症状、心功能，调节血流动力学，并可降低炎症反应，抑制氧化应激反应，减少再住院的发生，且具有一定安全性。

Objective To explore the therapeutic effect of Huoxue Tongluo Decoction combined with empagliflozin on patients with heart failure with reduced ejection fraction (HFrEF), and analyze its influence on traditional Chinese medicine syndrome scores and cardiac function. Methods A retrospective analysis was performed on 150 HFrEF patients treated in our hospital from August 2024 to August 2025. The patients were divided into control group and observation group according to different treatment regimens, 75 patients receiving empagliflozin alone constituted the control group, while another 75 cases treated with combined Huoxue Tongluo Decoction and empagliflozin were assigned to the observation group. The clinical efficacy, as well as the traditional Chinese medicine syndrome scores, Lee heart failure score, cardiac function 6-minute walk test (6MWT), heart failure factors [cardiac troponin I (cTnI), soluble suppression of tumorigenicity 2 (sST2) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)], hemodynamic parameters, inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-1β (IL-1β) and pentraxin-3 (PTX-3)], oxidative stress indexes [glutathione peroxidase-3 (GPX-3), malondialdehyde (MDA), superoxide dismutase (SOD), lipid peroxide (LPO) and total antioxidant capacity] before and after treatment were compared between the two groups. Adverse reactions and readmission rate were also compared. Results The total effective rate of observation group was higher than that of control group (P<0.05). After treatment, traditional Chinese medicine syndrome scores and Lee heart failure score in observation group were lower (P<0.05). LVEDD, LVESD, LVEDV, LVESD and serum levels of cTnI, sST2, NT-proBNP decreased, while LVEF and 6MWT increased in observation group (P<0.05). The improvement of hemodynamics in observation group was superior to control group after treatment (P<0.05). After treatment, serum levels of IL-6, CRP, IL-1β, PTX-3, MDA and LPO were decreased, while GPX-3, SOD and total antioxidant capacity were increased in observation group compared with control group (P<0.05). The readmission rate was lower in observation group (P<0.05). No significant difference was found in adverse reactions between the two groups (P>0.05). Conclusion Huoxue Tongluo Decoction combined with empagliflozin can elevate therapeutic efficacy, relieve clinical symptoms, improve cardiac function and hemodynamic status, reduce inflammatory and oxidative stress responses, and cut down readmission incidence with favorable safety in HFrEF patients.

       目的 探讨多组分运动干预联合多学科指导下营养干预应用于老年慢性心力衰竭（CHF）并发衰弱患者的效果。方法 选择郑州市第七人民医院收治的CHF并衰弱患者102例, 纳入时间为2023年11月—2024年10月, 按照随机数表法分为对照组51例给予常规运动干预+多学科指导下营养干预,观察组51例给予多组分运动干预+多学科指导下营养干预,观察两组衰弱状态、心功能指标、营养状况、生活质量、不良事件发生率。结果 与对照组相比,观察组干预后身体、心理、社会及总分明显更低（P<0.05）。与对照组相比,观察组干预后左室射血分数（LVEF）水平明显更高,超敏心肌肌钙蛋白T（hs-cTnT）、N末端B型利钠肽前体（NT-proBNP）、左室舒张末期内径（LVEDD）水平更低（P<0.05）。与对照组相比, 观察组干预后主观整体营养状况评价表（PG-SGA）评分明显更低,血红蛋白（Hb）、前白蛋白（PA）、白蛋白（ALB）水平更高（P<0.05）。与对照组相比,观察组干预后症状、身体、情感及总分更低（P<0.05）。观察组不良事件发生率（1.96%）低于对照组（15.69%）（P<0.05）。结论 对CHF并发衰弱患者应用多组分运动干预联合多学科指导下营养干预,能够减轻衰弱状态, 改善心功能及营养状况,促进生活质量的提升, 并降低不良事件发生率。

       Objective To explore the effect of multi-component exercise intervention combined with nutritional intervention under multidisciplinary guidance in elderly patients with chronic heart failure（CHF）and frailty．Methods From November 2023 to October 2024, 102 CHF patients with frailty admitted to Zhengzhou Seventh People's Hospital were selected and included． According to the computer grouping method, they were divided into a control group with 51 patients, received routine exercise intervention and multidisciplinary nutrition intervention,and an observation group with 51 patients, received multi-component exercise intervention and multidisciplinary nutrition intervention．The frailty status, cardiac function indicators, nutritional status, quality of life and incidence of adverse events were observed in both groups．Results Compared with the control group,the observation group showed significantly lower physical, psychological, social, and total scores after intervention（P<0.05）．Compared with the control group, the observation group showed significantly higher levels of left ventricular ejection fraction and lower levels of high-sensitivity cardiac troponin N-terminal pro-B-type natriuretic peptide, and left ventricular end-diastolic dimension after intervention（P<0.05）．Compared with the control group,the observation group had significantly lower Patient-Generated Subjective Global Assessment scores and higher levels of hemoglobin, prealbumin, and albumin after intervention（P<0.05）．Compared with the control group, the observation group had significantly lower symptoms, physical, emotional, and total scores after intervention（P<0.05）．The incidence of adverse events in the observation group（1.96%）was lower than that in the control group（15.69%）（P<0.05）．Conclusions Multi-component exercise intervention combined with multidisciplinary nutritional intervention in patients with CHF and frailty can alleviate frailty, improve cardiac function and nutritional status,quality of life, and reduce the incidence of adverse events．

      目的   残余胆固醇（RC）是反映动脉粥样硬化性血脂异常的重要指标，其在糖尿病合并冠心病患者中的临床意义尚不明确。本研究旨在探讨RC水平对糖尿病合并冠心病患者心力衰竭风险的预测价值，并分析其相关性。方法   本研究为回顾性横断面研究，纳入2021年1月—2024年1月期间在鹤壁市人民医院接受诊治的292例糖尿病合并冠心病患者。根据是否存在心力衰竭分为心力衰竭组（128例）和无心力衰竭组（164例）。对基线特征进行比较，采用单因素和多因素Logistic回归分析RC与心力衰竭的相关性。同时，通过限制性立方样条（RCS）分析探讨RC与心力衰竭风险的线性关系，并通过受试者操作特征（ROC）曲线和曲线下面积（AUC）评估RC的预测价值。结果   心力衰竭组患者的男性比例、高血压患病率、RC水平等高于无心力衰竭组，而估算肾小球滤过率水平显著降低（P＜0.05）。单因素分析显示，RC＞0.7 mmol/L显著增加心力衰竭风险（OR=1.854，95%CI：1.161~2.960，P=0.010）。多因素Logistic回归分析中，全调整模型结果显示，RC作为分类变量时，RC＞0.7 mmol/L的患者心力衰竭风险显著增加1.891倍（OR=1.891，95%CI：1.047~3.415，P=0.035）；作为连续变量时，RC每增加1单位，心力衰竭风险增加2.464倍（OR=2.464，95%CI：1.495~4.064，P＜0.001）；Log₁₀RC的风险比为6.411（95%CI：2.246~18.302，P=0.001）；标化RC的风险比为1.687（95%CI：1.262~2.255，P＜0.001）。限制性立方样条分析表明RC与心力衰竭风险呈线性正相关，ROC分析显示RC预测心力衰竭的AUC为0.621（95%CI：0.555~0.687，P＜0.001）。结论  RC水平与糖尿病合并冠心病患者心力衰竭风险显著相关，且呈线性正相关。RC具有一定的预测价值，可作为该人群心力衰竭风险评估的潜在指标。

       Objective  Residual cholesterol（RC）is  an important marker  reflecting  dyslipidemia  associated with atherosclerosis．Its clinical significance in patients with diabetes and coronary heart disease（CHD）remains unclear．To explore the predictive value of RC level for the risk of heart failure（HF）in patients with diabetes and CHD and analyze their association．Methods  This retrospective cross-sectional study included 292 patients with diabetes and CHD who were treated at Hebi People’s Hospital between January 2021 and January 2024．Patients were divided into the HF group（128 cases）and the non-HF group（164 cases）based on the presence of HF．Baseline characteristics were compared，and univariate and multivariate Logistic  regression analyses were performed to assess the association between RC and HF．Additionally，restricted cubic spline（RCS）analysis was used to explore the linear relationship between RC and HF risk，and the predictive value of RC was evaluated using receiveroperating characteristic（ROC）curves and the area under the curve（AUC）．Results  The HF group had significantly higher proportions of males，hypertension prevalence and RC levels，while estimated glomerular filtration rate were significantly lower compared to the non-HF group（P＜0.05）．Univariate analysis showed that RC＞0.7 mmol/L significantly increased the risk of HF（OR=1.854，95%CI：1.161–2.960，P=0.010）．In the fully adjusted multivariate Logistic regression model，RC（RC＞0.7 mmol/L）was associated with a 1.891-fold increased risk of HF as a categorical variable（OR=1.891，95%CI：1.047–3.415，P=0.035）．As a continuous variable，each increased unit in RC was associated with a 2.464-fold increased risk of HF（OR=2.464，95%CI：1.495–4.064，P＜0.001）．The odds ratios for Log₁₀RC and standardized RC were 6.411（95%CI：2.246–18.302，P=0.001）and 1.687（95%CI：1.262–2.255，P＜0.001），respectively．ROC analysis indicated a linear positive association between RC and HF risk（P=0.002）．ROC analysis showed that RC had predictive value for HF，with an AUC of 0.621（95%CI：0.555–0.687，P＜0.001）．Conclusions  RC levels are significantly associated with the risk of HF in patients with diabetes and CHD，demonstrating a linear positive correlation．RC has potential predictive value and may serve as a useful indicator for assessing HFrisk in this population．

目的 探究血清多配体蛋白聚糖-1（SCD-1）与可溶性血管内皮生长因子受体-2（sVEGFR-2）表达水平在老年慢性心力衰竭患者预后评估的判定价值。方法 选取2023年1月—2024年3月珠海市第五人民医院检验科收治的110例老年慢性心力衰竭患者,检测其血清SCD-1和sVEGFR-2水平,对患者进行随访调查,了解其再次由于心力衰竭住院、心源性死亡的情况。运用多因素Logistic回归分析,探究老年慢性心力衰竭患者预后影响因素。结果 Logistic回归分析显示,心功能分级（OR=3.433,95%CI：0.934~6.431）、B型脑钠肽升高（OR=2.462,95%CI：0.861~4.765）、血清SCD-1升高（OR=3.795,95%CI：0.972~6.894）、血清sVEGFR-2升高（OR=3.842,95%CI：0.942~6.912）为影响老年慢性心力衰竭患者预后不良的重要因素（P<0.05）;联合血清SCD-1和sVEGFR-2曲线下面积0.962与B型脑肽钠曲线下面积0.844,相较于单一SCD-1曲线下面积0.658、sVEGFR-2曲线下面积0.712明显偏高（P<0.05）。结论 经研究证实,老年慢性心力衰竭患者预后效果不理想,其血清SCD-1和sVEGFR-2监测水平异常升高,和老年慢性心力衰竭预后不佳存在关联性,可视为老年慢性心力衰竭患者判定预后效果的主要标志物。

Objective To investigate the prognostic value of serum syndecan-1（SCD-1）and soluble vascular endothelial growth factor receptor-2（sVEGFR-2）expression levels in elderly patients with chronic heart failure. Methods A total of 110 elderly patients with chronic heart failure admitted to our hospital were selected,with a time interval of January 2023 to March 2024．Serum SCD-1 and sVEGFR-2 levels were detected and follow-up investigations were conducted to understand their re hospitalization and cardiogenic death due to heart failure．Multiple logistic regression analysis was used to explore the prognostic factors affecting elderly patients with chronic heart failure. Results According to logistic retrospective analysis,heart function grading（OR=3.433,95%CI：0.934-6.431）,elevated B-type brain natriuretic peptide（OR=2.462,95%CI：0.861-4.765）,elevated serum SCD-1（OR=3.795,95%CI：0.972-6.894）,and elevated serum sVEGFR-2（OR=3.842,95%CI：0.942-6.912）were important factors affecting the poor prognosis of elderly patients with chronic heart failure,with differences P<0.05．The area under the curve of combined serum SCD-1 and sVEGFR-2 was 0.962,and the area under the curve of B-type brain peptide sodium was 0.844,which was significantly higher than that of a single SCD-1 curve of 0.658 and sVEGFR-2 curve of 0.712,with a difference of P<0.05. Conclusions Research has confirmed that the prognosis of elderly patients with chronic heart failure is not satisfied,and their serum SCD-1 and sVEGFR-2 monitoring levels are abnormally elevated,which is related to the poor prognosis of elderly patients with chronic heart failure．It can be regarded as the main biomarker for defining the prognosis of elderly patients with chronic heart failure．

目的 观察利伐沙班对心力衰竭（HF）合并心房颤动（AF）患者凝血因子及预后情况的影响。方法 采用前瞻性研究,纳入平顶山市第二人民医院2021年1月—2022年4月期间收治的123例HF合并AF患者,以数字随机表法将入组患者分为常规组（61例）和试验组（62）例,两组均行起搏器植入术（CRTD）治疗,常规组予以常规抗凝治疗辅助CRTD,试验组予以利伐沙班辅助CRTD,所有患者术后均开展一年随访,比较两组患者治疗前后的抗Xa凝血因子、心肌损伤标志物、心功能指标变化情况,以及术后血栓栓塞、心血管死亡事件发生情况。结果 治疗前,两组患者的Xa凝血因子,心肌损伤标志物,心功能指标比较差异无统计学意义（P>0.05）;在不同抗凝方案下,观察组治疗1 d后的抗Xa凝血因子为（130.44±20.18）IU/mg,治疗3 d后的抗Xa凝血因子为（115.36±20.77）IU/mg,治疗7 d的抗Xa凝血因子为（90.25±20.44）IU/mg,均低于常规组[（145.33±20.19）IU/mg、（128.45±20.16）IU/mg、（103.34±20.17）IU/mg],差异有统计学意义（P<0.05）。治疗后,试验组的肌酸激酶同工酶为（7.52±2.16）U/L,心肌肌钙蛋白Ⅰ为（0.52±0.12）ng/mL,乳酸脱氢酶为（126.41±20.45）U/L,均低于常规组[（8.44±2.28）U/L、（0.94±0.31）ng/mL、（140.33±20.25）U/L],差异有统计学意义（P<0.05）。治疗后,观察组的左室射血分数为（56.12±10.41）%,高于常规组（50.24±10.33）%,左室舒张末期内径为（47.11±10.25）mm,左室舒张末期容积为（36.72±10.43）mL,均低于常规组（53.28±10.14）mm、（42.77±10.36）mL,差异有统计学意义（P<0.05）。随访期间,试验组的血栓栓塞事件发生率为4.84%（3/62）,心血管死亡事件发生率为3.23%（2/62）,均低于常规组[19.67%（12/61）、14.75%（9/61）],差异有统计学意义（P<0.05）。结论 利伐沙班辅助CRTD能有效增强HF合并AF患者的抗Xa凝血因子活性,对减轻心肌损伤、改善心功能并降低血栓栓塞或心血管死亡风险均有积极意义。

Objective To observe the effect of rivaroxaban on coagulation factors and prognosis in patients of heart failure（HF）with atrial fibrillation（AF）．Methods This is a prospective study．The patients were included from January 2021 to April 2022 in Pingdingshan Second People’s Hospital．The study subjects were 123 patients with HF and AF．The enrolled patients were divided into the conventional group（61 cases）and the experimental group（62 cases）by the method of digital random table．Both groups were treated with cardiac resynchronization therapy with defibrillator（CRTD）．The conventional group was treated with conventional anticoagulation therapy to assist CRTD,and the experimental group was treated with rivaroxaban to assist CRTD．All patients were followed up for one year after surgery,the changes in anti-Xa coagulation factors,myocardial injury markers,cardiac function indicators,as well as the incidence of postoperative thromboembolism and cardiovascular death events between the two groups of patients before and after treatment were compared．Results Before treatment,there were no statistically significant differences in Xa coagulation factor,myocardial injury markers and cardiac function indicators between the two groups of patients（P>0.05）．Under different anticoagulation regimens,the anti-Xa coagulation factor levels in the observation group were（130.44±20.18）IU/mg after 1 day of treatment,（115.36±20.77）IU/mg after 3 days of treatment,and（90.25±20.44）IU/mg after 7 days of treatment,which were lower than that in the conventional group [（145.33±20.19）IU/mg,（128.45±20.16）IU/mg,（103.34±20.17）IU/mg]（P<0.05）．After treatment,the CK-MB level of the experimental group was（7.52±2.16）U/L,cTnI was（0.52±0.12）ng/mL,and LDH was（126.41±20.45）U/L,which were lower than that of the conventional group [（8.44±2.28）U/L,（0.94±0.31）ng/mL,（140.33±20.25）U/L]（P<0.05）．After treatment,the left ventricular ejection fraction of the observation group was（56.12±10.41）%,which was higher than the conventional group（50.24±10.33）%,left ventricular diameter was（47.11±10.25）mm,left ventricular end disastolic volume was（36.72±10.43）mL,which were lower than the conventional group（53.28±10.14）mm,（42.77±10.36）mL（P<0.05）．During the follow-up period,the incidence of thromboembolism events in the experimental group was 4.84%（3/62）,and the incidence of cardiovascular death events was 3.23%（2/62）,which was lower than the conventional group [19.67%（12/61）,14.75%（9/61）]（P<0.05）．Conclusions Rivaroxaban assisted CRTD can effectively enhance the activity of anti-Xa coagulation factors in patients with HF and AF,which has positive significance in reducing myocardial injury,improving cardiac function and reducing the risk of thromboembolism or cardiovascular death．

目的 分析厄贝沙坦+美托洛尔治疗慢性充血性心力衰竭(congestive heart failure,CHF)的临床效果及对患者心功能影响。方法 选取本院2018年12月—2020年12月住院治疗的200例慢性CHF患者,根据不同的治疗方法分组,参照组100例患者采用厄贝沙坦治疗,治疗组100例患者采用厄贝沙坦+美托洛尔治疗,比较2组临床疗效、心功能指标、血清炎性因子、血清N端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)水平、不良反应发生率。结果 治疗组临床总有效率(97.00%)高于参照组(87.00%),治疗组治疗后左室射血分数(left ventricular ejection fraction,LVEF)高于参照组,治疗组治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室收缩末期内径(left ventricular end systolic diameter,LVESd)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、NT-proBNP、Hcy水平均低于参照组,差异均具有统计学意义(P＜0.05)。治疗组不良反应发生率(4.00%)与参照组(5.00%)比较,P>0.05。结论 厄贝沙坦+美托洛尔可有效改善慢性CHF患者心功能,减轻炎症反应,抑制NT-proBNP、Hcy释放,且不良反应较少。

Objective To analyze the clinical effect of irbesartan combined with metoprolol in the treatment of chronic congestive heart failure (CHF) and its influence on cardiac function. Methods A total of 200 patients with chronic CHF in our hospital from December 2018 to December 2020 were selected and divided into two groups according to different treatment methods. One handred patients in the control group were treated with irbesartan, and 100 patients in the treatment group were treated with irbesartan + metoprolol. The clinical efficacy, cardiac function indexes, serum inflammatory factors, serum NT-proBNP, Hcy levels and adverse reactions of the two groups were compared. Results The total effective rate of the treatment group (97.00%) was higher than that of the control group (87.00%), LVEF of the treatment group was higher than that of the control group, LVEDd, LVESd, serum TNF-α, hs-CRP, IL-6, NT-proBNP, Hcy levels of the treatment group were lower than those of the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the treatment group (4.00%) was higher than that in the control group (5.00%),P>0.05. Conclusion Irbesartan + metoprolol could effectively improve cardiac function, reduce inflammatory reaction, inhibit the release of NT-proBNP and Hcy in patients with chronic CHF, with less adverse reactions.

目的 分析心力衰竭伴快速心房颤动(简称:心衰伴快速房颤)患者接受胺碘酮急诊抢救治疗的效果及对24 h心室率的影响。方法 将2017年1月—2020年12月急诊接诊且行西地兰治疗的60例心衰伴快速房颤患者作为对照组,将同期急诊接诊且行胺碘酮治疗的60例心衰伴快速房颤患者作为观察组,对组间心功能指标、炎症因子水平、心室率、临床疗效、药物不良反应展开分析。结果 ①组间心功能指标、炎症因子水平在治疗前无差异,P>0.05;观察组心功能指标、炎症因子水平在治疗后优于对照组,P<0.05;②组间心室率在治疗前无差异,P>0.05;观察组治疗后4 h、12 h、24 h心室率均低于对照组,P<0.05;③观察组5例无效(8.33%),对照组14例无效(23.33%),P<0.05;④观察组药物不良反应率(3.33%)与对照组药物不良反应率(5.00%)无差异,P>0.05。结论 在急诊抢救心衰伴快速房颤患者时采用胺碘酮,可以改善患者心功能、炎症反应、心室率,加之无明显不良反应,值得推广。

Objective To analyze the efficacy of emergency treatment with amiodarone and its influence on 24-hour ventricular rate in patients with heart failure and rapid atrial fibrillation. Methods From January 2017 to December 2020, 60 patients with heart failure and rapid atrial fibrillation who received emergency treatment and cedilanide treatment were selected as the control group, and 60 patients with heart failure and rapid atrial fibrillation who received emergency treatment and amiodarone treatment at the same period were selected as the observation group. Results ① There was no significant difference in cardiac function index and inflammatory factors level between the two groups before treatment, P>0.05.The cardiac function index and inflammatory factors level of the observation group were more improved than those of the control group after treatment, P<0.05. ② There was no significant difference in ventricular rate between the two groups before treatment, P>0.05.The ventricular rates of the observation group at 4 h, 12 h and 24 h after treatment were lower than those of the control group, P< 0.05. ③ Treatment for 5 cases (8.33%) in the observation group, 14 cases (23.33%) in the control group were ineffective, P<0.05. ④ There was no significant difference in the adverse drug reaction incidence between the observation group (3.33%) and the control group (5.00%), P>0.05. Conclusion Amiodarone could improve the cardiac function, inflammatory reaction and ventricular rate of patients with heart failure and rapid atrial fibrillation in emergency treatment, and there was no obvious adverse reaction, so it is worthy of promotion.

目的 分析基于微信平台步行运动训练对慢性充血性心力衰竭(CHF)患者心脏康复水平的影响。方法 本次研究对象来源于梅州市中医医院一内科2020年11月—2021年12月住院的90例CHF患者,根据随机数字表法分组(每组n=45),对比组给予常规药物治疗,观察组在对比组基础上给予基于微信平台步行运动训练治疗,对比两组临床疗效、心脏功能指标、血清NT-proBNP、D-D、6分钟步行距离、日常生活能力评分、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分。结果 观察组临床总有效率(95.56%)高于对比组(66.67%),观察组治疗后左心室舒张末期内径、左心室收缩末期内径均低于对比组,观察组治疗后左室射血分数高于对比组,观察组治疗后血清NT-proBNP、D-D均低于对比组,观察组治疗后6分钟步行距离、日常生活能力评分均高于对比组,观察组治疗后MLHFQ评分低于对比组,P＜0.05(差异均具有统计学意义)。结论 基于微信平台步行运动训练可有效改善CHF患者心功能,抑制NT-proBNP、D-D高表达,提高日常生活能力、生存质量。

Objective To analyze the effect of walking training through Wechat on cardiac rehabilitation of chronic congestive heart failure (CHF) patients. Methods A total of 90 patients with CHF hospitalized in the First Internal Medicine Department of Meizhou Traditional Chinese Medicine Hospital from November 2020 to December 2021 were enrolled in this study. They were divided into two groups according to the random number table method (45 patients in each group).The control group was given routine drug treatment,and the observation group was given walking training through Wechat on the basis of control group. The clinical efficacy,cardiac function indexes,serum NT-proBNP,D-D levels,6-minute walking distance,ability of daily life (ADL) score and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score were compared between two groups. Results The total clinical effective rate of the observation group (95.56%) was higher than that of the control group (66.67%),the LVEDd and LVESd of the observation group were lower than those of the control group after treatment,the LVEF of the observation group was higher than that of the control group after treatment,the serum NT-proBNP and D-D levels of the observation group were lower than those of the control group after treatment,the 6-minute walking distance and ADL score of the observation group were higher than those of the control group after treatment,and the MLHFQ score of the observation group was lower than that of the control group after treatment,P<0.05 (the difference was statistically significant).Conclusions Walking training by Wechat could effectively improve the cardiac function of CHF patients,inhibit the high expression of NT proBNP and D-D,and improve the ability of daily living and quality of life.