沙库巴曲缬沙坦治疗缺血性心肌病的临床价值分析

Clinical value of sakubatril-valsartan in treatment of ischemic cardiomyopathy

目的分析沙库巴曲缬沙坦治疗缺血性心肌病的临床价值,并为临床诊治提供参考。方法选择2017年1月至2018年4月于邢台市第三医院心内科收治的缺血性心肌病患者86例,采用随机数字表法分为观察组(n=43,予以沙库巴曲缬沙坦治疗)和对照组(n=43,予以依那普利治疗)。比较两组患者在治疗前及治疗12月后心功能、日常生活能力、血管扩张功能(FMD)及颈动脉内中膜厚度(CIMT);统计随访期间内并发症、主要不良心血管事件(MACE)及心力衰竭(心衰)再入院率。结果治疗后两组患者的左室舒张末期内径(LVEDD)较治疗前显著下降,左室射血分数(LVEF)较治疗前显著上升,观察组LVEDD显著低于对照组,LVEF显著高于对照组(P<0.05);治疗后两组Barthel指数(BI)较治疗前显著上升,明尼苏达州心衰生活质量问卷(MLHF-Q)较治疗前显著下降,观察组BI高于对照组,MLHF-Q评分显著低于对照组(P<0.05);治疗后两组CIMT均较治疗前有一定下降趋势,但无统计学意义(P>0.05);FMD则较治疗前显著上升,且观察组FMD显著高于对照组(P<0.05);观察组咳嗽发生率显著低于对照组,观察组心衰、恶性心律失常、心源性死亡及再入院率均显著低于对照组(P<0.05)。结论与依那普利治疗比较,沙库巴曲缬沙坦治疗缺血性心肌病对患者LVEDD、LVEF、FMD的改善更为显著,且明显降低咳嗽、恶性心律失常、心源性死亡及心衰再入院率。

Objective To analyze the clinical value of sakubatril-valsartan in treatment of ischemic cardiomyopathy(ICM),and provide reference for ICM diagnosis and treatment.Methods ICM patients(n=86)were chosen from Department of Cardiology in the Third Hospital of Xingtai City from Jan.2017 to Apr.2018,and divided,by using random digital table,into observation group(n=43,treated with sakubatril-valsartan)and control group(n=43,treated with enalapril).Before and after treatment for 12 months,the heart function,activities of daily living(ADL),flow-mediated dilation(FMD)and carotid intima-media thickness(CIMT)were compared between 2 groups.The complications,major adverse cardiovascular events(MACE)and re-hospitalization rate due to heart failure(HF)were given statistical treatment during follow-up period.Results After treatment,left ventricular end-diastolic inner diameter(LVEDD)decreased significantly and left ventricular ejection fraction(LVEF)increased significantly in 2groups,and LVEDD was significantly lower and LVEF was significantly higher in observation group than those in control group(P<0.05).After treatment,Barthel index(BI)increased significantly and scores of Minnesota Living with Heart Failure Questionnaire(MLHF-Q)decreased significantly in 2 groups,and BI was higher and MLHF-Q was significantly lower in observation group than those in control group(P<0.05).CIMT had some descending tendency in 2 groups without statistical significance after treatment(P>0.05),and FMD increased significantly,and FMD was significantly higher in observation group than that in control group(P<0.05).The incidence rate of cough was lower,and incidence rates of HF,malignant arrhythmia,cardiac death and re-hospitalization due to HF were significantly lower in observation group than those in control group(P<0.05).Conclusion Compared with enalapril,sakubatrilvalsartan has more significant effect on LVEDD,LVEF and FMD in ICM patients,and can significantly reduce the incidence rates of cough,malignant arrhythmia,cardiac death and re-hospitalization due to HF.