沙库巴曲缬沙坦钠治疗老年射血分数降低的心力衰竭疗效观察

Curative effect of sacubitril and valsartan sodium in the treatment of elderly patients with heart failure with reduced ejection fraction

目的探讨沙库巴曲缬沙坦钠治疗射血分数降低的心力衰竭(HFrEF)老年患者的临床疗效。方法选择2019年1月至2020年7月阜阳市人民医院收治的86例老年HFrEF患者为研究对象,根据治疗方法将患者分为对照组和观察组,每组43例。对照组患者给予盐酸贝那普利片10 mg,口服,每日1次,每2周对患者的药物耐受性进行评价,缓慢调整药物用量至每次20 mg,每日1次,连续治疗12周。观察组患者给予沙库巴曲缬沙坦钠片口服,每次50 mg,每日2次,每2周对患者的药物耐受性进行评价,缓慢调整药物用量至每次100 mg,每日2次,连续治疗12周。治疗后7 d,对2组患者的临床疗效进行评估,并计算总有效率。分别于治疗前和治疗后7 d,应用彩色多普勒超声检测2组患者心功能,包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和每搏输出量(SV);采用6 min步行实验评估2组患者的运动耐力,记录6 min步行距离(6MWD);采用全自动化学发光免疫分析法检测2组患者血清氨基末端脑利钠肽前体(NT-proBNP)、C反应蛋白(CRP)水平;采用酶联免疫吸附试验测定2组患者血清同型半胱氨酸(Hcy)水平。记录2组患者随访90 d内心力衰竭恶化、高钾血症、肾功能损伤的发生情况,并计算不良反应发生率。结果对照组患者显效16例,有效18例,无效9例,总有效率为79.07%(34/43);观察组患者显效24例,有效17例,无效2例,总有效率为95.35%(41/43);观察组患者治疗总有效率显著高于对照组(χ^(2)=5.108,P<0.05)。治疗前,2组患者的LVEF、LVEDD、SV、6MWD比较差异无统计学意义(P>0.05);2组患者治疗后7 d的LVEF、SV、6MWD显著高于治疗前,LVEDD显著低于治疗前(P<0.05);治疗后7 d,观察组患者的LVEF、SV、6MWD显著高于对照组,LVEDD显著低于对照组(P<0.05)。治疗前,2组患者的NT-proBNP、Hcy、CRP水平比较差异无统计学意义(P>0.05);2组患者治疗后7 d的NT-proBNP、Hcy、CRP水平均显著低于治疗前(P<0.05);治疗后7 d,观察组患者的NT-proBNP、Hcy、CRP水平显著低于对照组(P<0.05)。治疗后90 d内,对照组和观察组患者不良反应发生率分别为11.63%(5/43)和2.32%(1/43);2组患者的不良反应发生率比较差异无统计学意义(χ^(2)=2.867,P>0.05)。结论沙库巴曲缬沙坦钠对老年HFrEF患者具有良好的临床疗效,可提升患者的心功能,减轻炎症反应,且不良反应发生率低。

Objective To investigate the clinical efficacy of sacubitril and valsartan sodium in the treatment of elderly patients with heart failure with reduced ejection fraction(HFrEF).Methods A total of 86 elderly patients with HFrEF admitted to the Fuyang People′s Hospital from January 2019 to July 2020 were selected as the research objects.According to the treatment methods,the patients were divided into the control group and the observation group,with 43 cases in each group.The patients in the control group were given benazepril hydrochloride tablets orally,10 mg once a day,and the drug tolerance of the patients was evaluated every two weeks,and the drug dosage was slowly adjusted to 20 mg once a day,continuously twelve weeks of treatment.The patients in the observation group were given sacubitril and valsartan sodium tablets orally,50 mg twice a day,and the drug tolerance of the patients was evaluated every two weeks,and the drug dosage was slowly adjusted to 100 mg twice a day,continuously twelve weeks of treatment.At 7 days after treatment,the clinical efficacy of patients in the two groups was evaluated,and the total effective rate was calculated.Before treatment and 7 days after treatment,cardiac function was detected by color Doppler ultrasound,including left ventricular ejection fractions(LVEF),left ventricular end-diastolic diameter(LVEDD)and stroke volume(SV);the exercise tolerance of patients in the two groups was evaluated by 6-minute walking test,and 6-minute walking distance(6MWD)was recorded;the levels of N-terminal probrain natriuretic peptide(NT-proBNP)and C-reactive protein(CRP)in serum of patients in the two groups were detected by automatic chemiluminescence immunoassay;the level of homocysteine(Hcy)in serum of patients in the two groups was determined by enzyme-linked immunosorbent assay.The incidences of heart failure worsening,hyperkalemia and renal function damage within 90 days of follow-up of patients in the two groups were recorded,and the incidence of adverse reactions was calculated.Results In the control group,16 cases were markedly effective,18 cases were effective,and 9 cases were ineffective,with a total effective rate of 79.07%(34/43);in the observation group,24 cases were markedly effective,17 cases were effective,and 2 cases were ineffective,with a total effective rate of 95.35%(41/43);the total effective rate of patients in the observation group was significantly higher than that in the control group(χ^(2)=5.108,P<0.05).Before treatment,there was no significant difference in LVEF,LVEDD,SV and 6MWD of patients between the two groups(P>0.05);the LVEF,SV and 6MWD of patients in the two groups at 7 days after treatment were significantly higher than those before treatment,and the LVEDD was significantly lower than that before treatment(P<0.05);at 7 days after treatment,the LVEF,SV and 6MWD of patients in the observation group were significantly higher than those in the control group,and the LVEDD was significantly lower than that in the control group(P<0.05).Before treatment,there was no significant difference in the levels of NT-proBNP,Hcy and CRP in serum of patients between the two groups(P>0.05);the levels of NT-proBNP,Hcy and CRP in serum of patients in the two groups at 7 days after treatment were significantly lower than those before treatment(P<0.05);at 7 days after treatment,the levels of NT-proBNP,Hcy and CRP in serum of patients in the observation group were significantly lower than those in the control group(P<0.05).Within 90 days after treatment,the incidence of adverse reactions in the control group and observation group were 11.63%(5/43)and 2.32%(1/43),respectively;there was no significant difference in the incidence of adverse reactions between the two groups(χ^(2)=2.867,P>0.05).Conclusion Sacubatril and valsartan sodium has good clinical efficacy in elderly patients with HFrEF,which can improve patients′cardiac function,reduce inflammatory response,and has a low incidence of adverse reactions.