托伐普坦联合沙库巴曲缬沙坦钠治疗急性心力衰竭伴慢性肾功能不全疗效

Tolvaptan combined with sacubitril and valsartan sodium in the treatment of acute heart failure with chronic renal insufficiency

目的观察托伐普坦联合沙库巴曲缬沙坦钠治疗急性心力衰竭伴慢性肾功能不全患者的效果。方法选取2019年3月—2020年3月河北北方学院附属第一医院重症医学科收治急性心力衰竭伴慢性肾功能不全患者98例,依照随机数字表法分为观察组和对照组,每组49例。2组均给予常规药物治疗,对照组另予沙库巴曲缬沙坦钠治疗,观察组在对照组基础上再加用托伐普坦治疗,2组均治疗7 d。比较2组患者临床疗效,治疗前后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF),血β_(2)微球蛋白(β_(2)-MG)、肌酐(SCr)水平,以及不良反应和预后情况。结果治疗7 d后,观察组治疗总有效率高于对照组(93.88%vs.77.55%,χ^(2)/P=5.333/0.021);治疗后2组患者LVEDD、LVESD水平均降低,LVEF水平均升高(P<0.05),且观察组改善程度优于对照组(t/P=2.352/0.021,2.462/0.016,2.864/0.006);治疗后2组患者血β_(2)-MG、SCr水平均降低(P<0.05),且观察组低于对照组(t/P=3.333/<0.001,5.265/<0.001);2组不良反应发生率比较,差异无统计学意义(P>0.05);Kaplan-Meier生存分析结果显示,观察组无心血管死亡生存率高于对照组,差异有统计学意义(89.58%vs.72.34,χ^(2)=4.597,P=0.032)。结论托伐普坦联合沙库巴曲缬沙坦钠用于治疗急性心力衰竭伴慢性肾功能不全患者,能够改善心功能和肾功能,疗效确切,同时能够提高患者无心血管死亡生存率。

Objective To observe the effect of tolvaptan combined with sacubitril and valsartan sodium in the treatment of patients with acute heart failure and chronic renal insufficiency.Methods From March 2019 to March 2020,98 patients with acute heart failure and chronic renal insufficiency were admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Hebei North University.According to the random number table method,they were divided into observation group and control group,with 49 cases in each group..Both groups were treated with conventional drugs,the control group was additionally treated with sacubitril and valsartan sodium,and the observation group was treated with tolvaptan on the basis of the control group.Both groups were treated for 7 days.To compare the clinical efficacy of the two groups of patients,before and after treatment,left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),bloodβ_(2) microglobulin(β_(2)-MG),creatinine(SCr)Level,as well as adverse reactions and prognosis.Results After treatment,the total effective rate of treatment in the observation group was higher than that in the control group(93.88%vs.77.55%,χ^(2)//P=5.333/0.021).After treatment,the levels of LVEDD and LVESD of the two groups decreased,and the levels of LVEF increased(P<0.05),and the improvement of the observation group was better than that of the control group(t/P=2.352/0.021,2.462/0.016,2.864/0.006).After treatment,the levels of β_(2) MG and SCr in the two groups of patients decreased(P<0.05),and the observation group was lower than the control group(t/P=3.333/<0.001,5.265/<0.001).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Kaplan Meier survival analysis showed that the survival rate without cardiovascular death in the observation group was higher than that in the control group,and the difference was statistically significant(89.58%vs.72.34,χ^(2)/=4.597,P=0.032).Conclusion Tolvaptan combined with sacubitril and valsartan sodium is used for the treatment of patients with acute heart failure and chronic renal insufficiency,which can improve heart and kidney function,with definite curative effect,and can improve the survival rate of patients without cardiovascular death.