目的 探究曲美他嗪（TMZ）片剂对老年缺血性心肌病（ICM）心力衰竭（HF）患者运动耐量和生活质量的影响。方法 选取2018年1月至2019年12月于南充市中心医院心内科收治的ICM合并HF患者136例，按1:1的比例随机分为对照组和观察组，两组均予以诊疗指南标准化治疗，观察组加用曲美他嗪片，20 mg，3/d，连续口服6个月。经胸超声心动图检查左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD），计算左室射血分数（LVEF）。同时患者完成6分钟步行试验（6MWT）、心肺运动耐量试验和明尼苏达HF生活质量问卷调查。结果 治疗后，两组患者的VO2峰值、无氧阈和代谢当量较治疗前升高，生活质量评分较治疗前降低（P＜0.05），且观察组患者的总有效率、LVEF、6MWT、VO2峰值、无氧阈和代谢当量均高于对照组，同时生活质量评分低于对照组（P＜0.05）。两组患者均未发生严重的药物不良反应，观察组6个月内再住院率明显低于对照组（P＜0.05）。结论 在常规治疗HF的基础上联用曲美他嗪可显著提高老年缺血性心肌病HF患者的临床疗效，提高左心功能和心肺运动耐量，且无严重不良反应，改善患者生活质量。

Objective To comprehensively explore the effects of trimetazidine (TMZ) tablets on exercise capacity and life quality in elderly patients with heart failure with ischemic cardiomyopathy (ICM). Methods A total of 136 patients with ICM complicated with HF admitted to the Department of Cardiology of Nanchong Central Hospital from January 2018 to December 2019 were selected and randomly divided into control and observation groups at a ratio of 1:1. According to the diagnosis and treatment guidelines, the two groups were treated with standardized treatment. The observation group was treated orally with TMZ sustained-release tablets, 20 mg/time, and tid for six months. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) were examined by echocardiography, and left ventricular ejection fraction (LVEF) was calculated. In addition, the patients completed the 6-minute walking test (6MWT), the cardiopulmonary exercise tolerance test, and the Minnesota heart failure quality of life questionnaire. Results After treatment, the peak VO2 value, anaerobic threshold, and metabolic equivalents in the two groups increased while the life quality scores decreased (P<0.05). And the total effective rate, LVEF, 6MWT, peak VO2 value, anaerobic threshold, and metabolic equivalents in the observation group were significantly higher than that in the control group (P<0.05), and the life quality scores were lower than those in the control group (P<0.05). No severe adverse drug reactions occurred in the two groups, and the readmission rate in the observation group within six months was significantly lower than that in the control group (P<0.05). Conclusion Combined application of TMZ sustained-release tablets based on the conventional treatment of heart failure can significantly improve the clinical efficacy of elderly patients with heart failure with ischemic cardiomyopathy, and improve left cardiac function and cardiopulmonary exercise capacity without severe adverse reactions, to improve the quality of life quality.

四川省南充市市校科技战略合作项目(18SXHZ0367)