诺欣妥联合心脏运动康复对射血分数降低的心力衰竭疗效的研究

Effect of Entresto Combined with Cardiac Exercise Rehabilitation in Heart Failure Patients with Reduced Ejection Fraction

目的:探讨诺欣妥联合心脏运动康复对射血分数降低(HFr EF)的心力衰竭(HF)的临床疗效。方法:将我院心内科于2018年1月~2019年4月收治的70例HFr EF患者随机分为两组,各35例。对照组均给予诺欣妥规范治疗,实验组在此基础上根据心肺运动测试(CPET)测得代谢当量制定个性化心脏运动康复,包括院内、院外心脏康复干预及定期随访,为期6个月。采用彩色心脏超声诊断仪、心肺运动测试(CPET)分析两组治疗前后心肺功能变化,同时观察住院及随访期间的预后情况。结果:治疗6个月后,两组左心室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左心室射血分数(LVEF)均明显改善,且实验组显著优于对照组(P<0.05)。治疗6个月后,实验组AT明显升高,峰值VO2/kg、峰值VO2水平均有一定程度上升,且明显优于对照组(P<0.05)。与对照组比较,实验组90d内HF再住院率(8.6%vs.28.6%)、随访期间MACEs发生率(17.1%vs.40.0%)均显著降低(P<0.05)。结论:诺欣妥联合心脏运动康复治疗可使HFr EF患者显著获益,在改善心肺功能、运动能力及近期预后方面疗效显著,可作为HFr EF患者的一线治疗方案。

Objective: To explore the effect of entresto combined with cardiac exercise rehabilitation in heart failure patients with reduced ejection fraction(HFr EF). Methods: 70 patients with HFr EF admitted to the department of cardiology of our hospital From January 2018 to April 2019 were randomly divided into two group. The control group(n=35) was given standard treatment with entresto,and the experimental group(n=35) was formulated personalized cardiac exercise rehabilitation based on the metabolic equivalent measured by cardiopulmonary exercise test(CPET), including in-hospital and out-of-hospital cardiac rehabilitation intervention and regular follow-up for 6 months. Color echocardiography and cardiopulmonary exercise(CPET) were used to analyze the changes of cardiopulmonary function before and after treatment in the two groups, and the prognosis during hospitalization and follow-up was observed. Results: After 6 months of treatment, the levels of left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular ejection fraction,(LVEF) were significantly improved in both groups, and the indicators in the experimental group was significantly better than those in the control group(P<0.05). After 6 months of treatment, the AT of the experimental group was significantly increased, levels of peak VO2/kg and peak VO2 were also significantly increased, and were significantly better than those in the control group(P<0.05). Compared with the control group, the HF rehospitalization rate within 90 d(8.6%vs.28.6%) and MACEs incidence(17.1% vs.40.0%) in the experimental group were significantly reduced(P<0.05). Conclusions:Entresto combined with cardiac exercise rehabilitation therapy can be significantly beneficial for HFr EF patients, it has significant efficacy in improving cardiopulmonary function, motor ability and short-term prognosis, which can be used as the first-line treatment for HFr EF patients.