目的：探究温阳益气活血汤治疗射血分数保留性心力衰竭患者微血管内皮的影响。方法：通过对2020.09-2022.10来我院就诊的保留性射血分数型心力衰竭（HFpEF）患者进行筛查，选取符合标准的118例HFpEF患者按照随机法分为西药组和联合组，每组各（n=59）进行观察。入院后两组患者根据病情给予西药治疗，联合组患者采用西药治疗的基础上加用中药温阳益气活血汤。观察两组治疗前后６min步行距离(６MWT)、左室射血分数(LVEF)等心功能指标;左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)等心肌重塑指标,血清超氧化物歧化酶(SOD)、一氧化氮(NO)、丙二醛（MDA）等氧化应激指标，血清血管生长因子(VEGF）、血栓素（TVB2）、内皮素（ET-1）等血管内皮功能指标。分析两组疗效差异，判断温阳益气活血汤治疗HFpEF的临床疗效。结果：治疗后，联合组治疗总有效率为96.61%，高于西药组83.05%；治疗前，两组患者６MWT、LVEF比较，P＞0.05；治疗后，两组患者６MWT、LVEF均得到改善，且联合组患者高于西药组，P＜0.05；治疗前，两组患者 LVEDD、LVESD比较，P＞0.05；治疗后，两组患者LVEDD、LVESD均得到改善，且联合组患者低于西药组，P＜0.05；治疗前，两组患者SOD、NO、MDA比较，P＞0.05；治疗后，两组患者SOD、NO以及MDA均得到改善，且联合组SOD高于西药组，NO、MDA低于西药组，P＜0.05；治疗前，两组患者VEGF、TVB2和ET-1比较，P＞0.05。治疗后，两组患者VEGF、TVB2以及ET-1均得到改善，且联合组VEGF高于西药组，TVB2、ET-1低于西药组，P＜0.05。结论：在常规西药治疗基础上，联合温阳益气活血汤治疗HFpEF，能够有效改善患者机体氧化应激与心肌功能，抑制心肌重塑，安全性极高，值得临床推广。

Objective: Exploring the effect of Wenyang Yiqi Huoxue Tang on microvascular endothelium in patients with ejection fraction preserved heart failure. Method: By screening patients with preserved ejection fraction heart failure (HFpEF) who visited our hospital from September 2020 to October 2022, 118 HFpEF patients who met the criteria were randomly divided into a Western medicine group and a combination group, with each group (n=59) for observation. After admission, two groups of patients were treated with Western medicine based on their condition, while the combined group of patients received Western medicine treatment in addition to the traditional Chinese medicine Wenyang Yiqi Huoxue Tang. Observe cardiac function indicators such as 6-minute walking distance (6MWT) and left ventricular ejection fraction (LVEF) before and after treatment in both groups; Left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and other myocardial remodeling indicators, serum superoxide dismutase (SOD), nitric oxide (NO), malondialdehyde (MDA) and other oxidative stress indicators, serum vascular growth factor (VEGF), thromboxane (TVB2), endothelin (ET-1) and other vascular endothelial function indicators. Analyze the difference in efficacy between the two groups and determine the clinical efficacy of Wenyang Yiqi Huoxue Tang in treating HFpEF. Result: After treatment, the total effective rate of the combination group was 96.61%, which was higher than 83.05% in the Western medicine group; Before treatment, the comparison of 6MWT and LVEF between the two groups of patients showed a P>0.05; After treatment, both groups of patients showed improvement in 6MWT and LVEF, and the combination group had higher levels of patients compared to the Western medicine group (P<0.05); Before treatment, the LVEDD and LVESD of the two groups of patients were compared, P>0.05; After treatment, LVEDD and LVESD in both groups of patients improved, and the combined group was lower than the Western medicine group (P<0.05); Before treatment, the comparison of SOD, NO, and MDA between the two groups of patients showed a P>0.05; After treatment, the SOD, NO, and MDA levels in both groups of patients were improved, and the SOD levels in the combination group were higher than those in the Western medicine group, while NO and MDA levels were lower than those in the Western medicine group (P<0.05); Before treatment, the comparison of VEGF, TVB2, and ET-1 between the two groups of patients showed a P>0.05. After treatment, the levels of VEGF, TVB2, and ET-1 in both groups of patients improved, and the combined group had higher levels of VEGF than the Western medicine group, while TVB2 and ET-1 were lower than the Western medicine group, P<0.05. Conclusion: On the basis of conventional Western medicine treatment, combined with Wenyang Yiqi Huoxue Tang to treat HFpEF can effectively improve patients' oxidative stress and myocardial function, inhibit myocardial remodeling, and have high safety, which is worthy of clinical promotion.

河北省中医药管理局科研计划项目