Objective To investigate the efficacy of spironolactone plus metoprolol treatment for elderly patients with chronic heart failure and the effects on endothelin,brain natriuretic peptide(BNP) and cardiac function.Methods Total of 240 elderly patients with chronic heart failure in Huaihe Hospital of Henan Uni-versity from Dec.2014 to Feb.2015 were included in the study and divided into an observation group and a control group according to the random number table method,120 cases in each group.The control group received conventional drug treatment,i.e.inotropic drugs,angiotensin-converting enzyme inhibitors,and diu-retics etc.,for cardiac function Ⅳ stage patients digitalis cardiac drugs could be appropriately added; the observation group was added with spironolactone plus metoprolol,oral spironolactone 40 mg,once every morn-ing and night respectively,50 mg oral metoprolol at the same time.The clinical efficacy,endothelin and BNP level changes,cardiac function(left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume) changes of the two groups were observed and compared.Results After treatment,the total effective rate of the observation group was higher than the control group [96.6%(116/120) vs 80.0%(96/120)],the difference was statistically significant(P<0.05).After treatment,endothe-lin and brain natriuretic peptide of the observation group were lower than the control group [(38 ±5) ng/L vs (49 ±6) ng/L,(87 ±6) ng/L vs (98 ±6) ng/L],the differences were statistically significant(P <0.01).After treatment,left ventricular ejection fraction of the observation group was higher than the control group[ ( 46 ±5 )% vs ( 41 ±5 )%] , left ventricular end-diastolic volume and left ventricular end-systolic volume were lower than the control group[(87 ±9 ) mL vs (98 ±9) mL, (42 ±6) mL vs (51 ±6) mL], the differences were statistically significant ( P <0.01 ) .The incidence of complications of the observation group was lower than the control group[1.7%(2/120) vs 10.0%(12 /120)], the difference was statisti-cally significant (χ2 =7.585,P <0.05).Conclusion For the treatment of elderly patients with chronic heart failure,conventional drug therapy combined with spironolactone and metoprolol have better clinical effi-cacy,which can reduce the body endothelin and BNP level,and improve cardiac function.%目的：探讨螺内酯联合美托洛尔治疗老年慢性心力衰竭的疗效及对血浆内皮素、脑钠肽与心功能的影响。方法选取2014年12月至2015年2月河南大学淮河医院收治的老年慢性心力衰竭患者240例，按照随机数字表法分为观察组和对照组，每组120例。对照组采取传统的药物治疗方式，即予以患者正性肌力药物、血管紧张素转换酶抑制剂、利尿剂等药物治疗，心功能为Ⅳ级的患者可以适当加入洋地黄类强心药物治疗；观察组在常规药物的基础上服用螺内酯联合美托洛尔，即予以患者口服40 mg螺内酯，早晚各1次，同期口服50 mg美托洛尔，早晚各1次。观察比较两组患者临床疗效，治疗前后的血浆内皮素、脑钠钛、心功能（左心室射血分数、左心室舒张末期容积及左心室收缩末期容积）水平变化及并发症发生情况。结果治疗后，观察组总有效率高于对照组[96．6％（116／120）比80．0％（96／120）]，差异有统计学意义（P＜0．05）。治疗后，观察组血浆内皮素、脑钠钛水平低于对照组[（38±5） ng／L比（49±6） ng／L，（87±6） ng／L比（98±6） ng／L]，差异有统计学意义（P ＜0．01）。治疗后，观察组左心室射血分数高于对照组[（46±5）％比（41±5）％]，左心室舒张末期容积、左心室收缩末期容积低于对照组[（87±9） mL 比（98±9） mL，（42±6） mL 比（51±6） mL]，差异有统计学意义（P＜0．01）。观察组并发症发生率低于对照组[1．7％（2／120）比10．0％（12／120）]，差异有统计学意义（χ2＝7．585，P＜0．05）。结论对于老年慢性心力衰竭患者的治疗，在传统药物治疗的基础上联合应用螺内酯联合美托洛尔具有较好的临床疗效，能够降低体内血浆内皮素及脑钠钛水平，同时对心脏功能也有较好的改善效果。
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