伊伐布雷定联合沙库巴曲缬沙坦钠治疗心肌梗死并发心力衰竭患者的临床效果

Effects of ivabradine combined with sacubatrel/valsartan in the treatment of myocardial infarction complicated with heart failure

目的探讨伊伐布雷定联合沙库巴曲缬沙坦钠治疗心肌梗死并发心力衰竭患者的临床效果。方法选取2019年12月至2020年6月于抚顺市中心医院心内科住院的100例心肌梗死并发心力衰竭患者作为研究对象,采用随机数字表法将其分为观察组与对照组,各50例。两组患者采用标准化抗心力衰竭治疗,对照组应用沙库巴曲缬沙坦钠,观察组在对照组基础上联合口服伊伐布雷定,比较两组临床疗效、心功能指标变化、血清指标变化。结果观察组治疗有效率明显高于对照组,差异有统计学意义(P<0.05);观察组治疗后左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)明显低于对照组,左室射血分数(LVEF)、每分钟心排量(CO)明显高于对照组,差异有统计学意义(P<0.05);观察组治疗后N端脑钠前肽(NT-pro BNP)、血浆肾素活性(PRA)、抗利尿激素(ADH)、血清肾素(NE)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平明显低于对照组,差异有统计学意义(P<0.05)。结论伊伐布雷定联合沙库巴曲缬沙坦钠具有减少心肌耗氧量、逆转心脏重构、改善心功能的作用,适用于心肌梗死并发心力衰竭的治疗。

Objective To study the curative effects of ivabradine combined with sacubatrel/valsartan in the treatment of myocardial infarction complicated with heart failure. Methods 100 patients with myocardial infarction complicated with heart failure admitted to the Department of Cardiology of Fushun Central Hospital from December 2019 to June 2020 were randomly divided into control group(n=50) and observation group(n=50). 2 groups of patients were treated with standardized anti heart failure treatment, the control group was treated with sacubatre/valsartan sodium tablets, and the observation group was treated with oral ivabradine on the basis of the control group. The clinical efficacy, changes of cardiac function indexes and serum factor indexes of the 2 groups were compared. Results The effective rate of the observation group was significantly higher than that of the control group, the difference was statistically significant(P<0.05);the left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) of the observation group after treatment were significantly lower than those of the control group;the Left ventricular ejection fraction(LVEF) and cardiac output per minute(CO) of the observation group were significantly higher than those of the control group, the difference was statistically significant(P<0.05);the brain natriuretic peptide(NT-pro BNP), plasma renin activity(PRA), antidiuretic hormone(ADH), serum renin(NE), angiotensin Ⅱ(Ang Ⅱ),aldosterone(ALD) levels were significantly lower than those in the control group(P<0.05). Conclusion Ivabradine combined with salkubatrox valsartan can reduce myocardial oxygen consumption, reverse cardiac remodeling and improve cardiac function,which is suitable for the treatment of myocardial infarction complicated with heart failure.