基于心肺运动测试系统评价沙库巴曲缬沙坦治疗慢性心力衰竭的应用价值

The application value of sakubatril valsartan in the treatment of chronic heart failure based on cardiopulmonary exercise test system

目的基于心肺测试系统分析沙库巴曲缬沙坦治疗慢性心力衰竭(CHF)的临床价值。方法选择济宁医学院附属医院2019年1月至2020年8月收治的135例CHF患者为研究对象,按随机数字表法分为观察组(67例)和对照组(68例)。两组均接受比索洛尔治疗,观察组联合沙库巴曲缬沙坦,对照组联合贝那普利,比较两组的疗效、心功能指标水平,并采用心肺运动测试系统测定两组最大运动时间(Tmax)、最大运动功率(Wmax)、峰值氧耗量(Peak VO2)、无氧阈氧耗量(VO2AT),统计两组不良反应发生情况。结果观察组总有效率高于对照组[92.54%(62/67)比77.94%(53/68)],差异有统计学意义(χ^(2)=5.70,P<0.05)。治疗后观察组氨基末端脑利钠肽前体(NT-proBNP)、可溶性ST2(sST2)水平低于对照组[(2000.47±517.85)ng/L比(2777.39±812.49)ng/L、(0.33±0.10)μg/L比(0.37±0.09)μg/L],左心室射血分数(LVEF)高于对照组[(8.12±6.44)%比(41.93±6.73)%],差异有统计学意义(P<0.05)。治疗后观察组左室舒张末期内径(LVEDd)、左室收缩末期内径(LVEDs)、左室质量指数(LVMI)、左房容积指数(LAVI)低于对照组[(55.47±6.93)mm比(62.00±7.18)mm、(37.14±6.36)mm比(41.35±6.43)mm、(136.76±7.13)mg/m2比(140.98±7.47)mg/m2、(28.23±2.59)ml/m2比(31.98±2.17)ml/m2],差异有统计学意义(P<0.05);治疗后观察组Tmax、Wmax、Peak VO2、VO2AT高于对照组[(619.08±65.36)s比(58.70±52.44)s、(142.96±16.05)W比(124.19±13.38)W、(20.00±5.74)ml/(min·kg)比(18.13±3.58)ml/(min·kg)、(13.89±3.69)ml/(min·kg)比(11.23±2.36)ml/(min·kg)],差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结果沙库巴曲缬沙坦治疗CHF不仅可优化疗效,有利于心功能改善,对CHF患者心脏运动康复也有益,且不增加安全性风险。

Objective To analyze the application value of sakubatril valsartan in the treatment of chronic heart failure(CHF)based on cardiopulmonary test system.Methods One hundred and thirty-five CHF patients admitted to the Affiliated Hospital of Jining Medical Collegefrom January 2019 to August 2020 were divided into the observation group(67 cases)and the control group(68cases)by random number table method.Both groups were treated with bisoprolol.The observation group was treated with the combination of sakubatril valsartan,and the control group was treated with the combination of benapril.The efficacy and cardiac function indicators of the two groups were compared.The cardiopulmonary exercise test system was used to measure the patient′s maximum exercise time(Tmax),maximum exercise Watt(Wmax),peak volume oxygen(Peak VO2)and volume of anaerobic threshold oxygen(VO2AT),and the incidence of adverse reactions were calculated.Results The total effective rate in the observation group was higher than that in the control group:92.54%(62/67)vs.77.94%(53/68),the difference was statistically significant(χ^(2)=5.70,P<0.05).After the treatment,the levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and soluble ST2(sST2)in the observation group were lower than those in the control group:(2000.47±517.85)ng/L vs.(2777.39±812.49)ng/L,(0.33±0.10)μg/L vs.(0.37±0.09)μg/L,and the left ventricular ejection fraction(LVEF)was higher than that in the control group:(8.12±6.44)%vs.(41.93±6.73)%,the differences were statistically significant(P<0.05).After the treatment,the left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVEDs),left ventricular mass index(LVMI),left atrial volume index(LAVI)in the observation group were lower than those in the control group:(55.47±6.93)mm vs.(62.00±7.18)mm,(37.14±6.36)mm vs.(41.35±6.43)mm,(136.76±7.13)mg/m2 vs.(140.98±7.47)mg/m2,(28.23±2.59)ml/m2 vs.(31.98±2.17)ml/m2;the Tmax,Wmax,PeakVO2 and VO2AT in the observation group were higher than those in the control group:(619.08±65.36)s vs.(58.70±52.44)s,(142.96±16.05)W vs.(124.19±13.38)W,(20.00±5.74)ml/(min·kg)vs.(18.13±3.58)ml/(min·kg),(13.89±3.69)ml/(min·kg)vs.(11.23±2.36)ml/(min·kg),the differences were statistically significant(P<0.05).However,there was no statistically significant in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Sakubatril valsartan in the treatment of CHF can not only optimize the efficacy and improve cardiac function,but also benefit cardiac exercise rehabilitation of patients,and not increase the safety risk.