沙库巴曲缬沙坦联合托伐普坦治疗肺动脉高压所致右心衰竭疗效观察

Efficacy of sacubitril/valsartan combined with tolvaptan in treatment ofpulmonary arterial hypertension-induced right heart failure

目的:观察沙库巴曲缬沙坦联合托伐普坦治疗肺动脉高压所致右心衰竭的疗效。方法:选取肺动脉高压致右心衰竭患者120例,通过单双号法分为常规组(60例,单号,给予沙库巴曲缬沙坦)与联用组(60例,双号,给予沙库巴曲缬沙坦联合托伐普坦)。比较两组患者右心功能[右心射血分数(RVEF)、右心舒张末期容积(RVEDV)和右心收缩末期容积(RVESV)]、运动耐力[步行6 min距离(6MWD)、峰值耗氧量(PeakVO_(2))]、血清相关物质[血清钠、血肌酐(Scr)、抗利尿激素(ADH)]、心衰标志物[N末端脑钠肽前体(NT-proBNP)、肌钙蛋白I(cTnI)、血管紧张素(PRA)]及药物不良反应。结果:治疗后,两组RVEF上升,RVEDV和RVESV下降,且联用组RVEF高于常规组,RVEDV和RVESV低于常规组(均P<0.05);两组6MWD和PeakVO_(2)上升,VE/VCO_(2 )slop下降,且联用组6MWD和PeakVO_(2)高于常规组,VE/VCO_(2 )slop低于常规组(均P<0.05);两组血清钠上升,Scr和ADH下降,且联用组血清钠高于常规组,Scr和ADH低于常规组(均P<0.05);两组NT-proBNP、cTnI、PRA下降,且联用组低于常规组(均P<0.05)。两组不良反应发生率比较无统计学差异(P>0.05)。结论:沙库巴曲缬沙坦联合托伐普坦可有效治疗肺动脉高压所致右心衰竭,提高患者右心功能与运动能力,调节血液生化指标,不良反应小,安全性高。

Objective:To observe the efficacy of sacubitril/valsartan combined with tolvaptan in the treatment of pulmonary arterial hypertension-induced right heart failure.Methods:A total of 120 patients with pulmonary arterial hypertension-induced right heart failure were divided into conventional group(60 cases,odd number,treated with sacubitril/valsartan)and combination group(60 cases,even number,treated with sacubitril/valsartan combined with tolvaptan)by odd and even number method.The right ventricular function(RVEF,RVEDV and RVESV),exercise endurance(6MWD and PeakVO_(2)),serum related material(serum sodium,Scr,ADH),and heart failure markers(NT-proBNP,cTnI,PRA)and adverse drug reactions were compared between the two groups.Results:After treatment,RVEF increased,RVEDV and RVESV decreased in the two groups,and RVEF in the combination group was higher than that in the conventional group,and RVEDV and RVESV were lower than those in the conventional group(all P<0.05);6MWD and PeakVO_(2) increased,VE/VCO_(2) slop decreased in the two groups,and 6MWD and PeakVO_(2) in the combination group were higher than those in the conventional group,VE/VCO_(2) slop was lower than that in the conventional group(all P<0.05);the serum sodium increased,Scr and ADH decreased in the two groups,and the serum sodium in the combination group was higher than that in the conventional group,and Scr and ADH were significantly lower than those in the conventional group(all P<0.05);the levels of NT-proBNP,cTnI and PRA decreased in the two groups,and those in the combination group were lower than those in the conventional group(all P<0.05).There were no statistical differences in the incidence rates of adverse drug reactions between two groups(P>0.05).Conclusion:Sacubitril/valsartan combined with tolvaptan can effectively treat right heart failure caused by pulmonary arterial hypertension,improve the patient’s right heart function and exercise capacity,regulate blood biochemical indicators,with small adverse reactions and high safety.