沙库巴曲缬沙坦钠治疗冠心病合并慢性心力衰竭患者的临床效果及对心功能和血压的影响

Effects of sacubitril valsartan sodium on patients with coronary atherosclerotic heart disease combined with chronic heart failure and its influence on cardiac function and blood pressure

目的探讨沙库巴曲缬沙坦钠治疗冠心病(冠状动脉粥样硬化性心脏病)合并慢性心力衰竭(CHF)患者的临床效果及对心功能和血压的影响。方法选取2019年2月至2021年7月河南科技大学第一附属医院收治的102例冠心病合并CHF患者,采用随机数字表法分为对照组和观察组,各51例。2组患者均给予冠心病常规治疗,此外针对CHF,对照组采用β受体阻滞剂、醛固酮拮抗剂以及坎地沙坦酯方案治疗,观察组使用沙库巴曲缬沙坦钠替换对照组中坎地沙坦酯治疗。治疗3个月后比较2组临床疗效。比较2组治疗前和治疗3个月后的左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期内径(LVEDD)、N末端B型脑钠肽前体(NT-proBNP)、6 min步行距离(6MWD)、收缩压、舒张压以及不良反应发生情况。结果治疗后,观察组总有效率高于对照组[80.4%(41/51)比56.9%(29/51)],差异有统计学意义(P=0.010)。治疗3个月后,2组LVEF、LVFS均高于治疗前,NT-proBNP水平均低于治疗前,且观察组LVEF、LVFS高于对照组,NT-proBNP水平低于对照组,差异均有统计学意义(均P<0.05)。2组LVEDD治疗前后组间及组内比较差异均无统计学意义(均P>0.05)。治疗3个月后,2组6MWD均长于治疗前,收缩压和舒张压均低于治疗前,差异均有统计学意义(均P<0.05)。治疗期内2组不良反应发生率比较,差异无统计学意义(P=0.695)。结论沙库巴曲缬沙坦钠治疗冠心病合并CHF疗效确切,可有效改善患者心功能,明显降低血压,但对于血压较低的患者需加强监测。

Objective To explore the curative effect of sacubitril valsartan sodium on coronary atherosclerotic heart disease combined with chronic heart failure(CHF)and its influence on cardiac function and blood pressure.Methods A total of 102 patients with both coronary atherosclerotic heart disease and CHF admitted to the First Affiliated Hospital of Henan University of Science and Technology were enrolled from February 2019 to July 2021.According to random number table method,they were divided into control group and observation group,with 51 cases in each group.Both groups were given routine treatment for coronary atherosclerotic heart disease.In addition,control group was treated withβ-blocker,aldosterone antagonist and candesartan cilexetil for CHF,while observation group was treated withβ-blocker,aldosterone antagonist and sacubitril valsartan sodium.The clinical effects of the two groups were compared 3 months after treatment.Left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),left ventricular end diastolic diameter(LVEDD),N-terminal pro-brain type natriuretic peptide(NT-proBNP),6 min walking distance(6 MWD),systolic blood pressure(SBP),diastolic blood pressure(DBP)and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the total effective rate of the observation group was higher than that of the control group[80.4%(41/51)vs 56.9%(29/51)](P=0.010).After 3 months of treatment,LVEF and LVFS in the two groups were higher than those before treatment,and LVEF and LVFS in the observation group were higher than those in the control group;the level of NT-proBNP was lower than that before treatment,and NT-proBNP level in the observation group was lower than that in the control group(all P<0.05).There was no significant difference in LVEDD between the two groups before and after treatment(all P>0.05).After 3 months of treatment,6 MWD in both groups were longer than those before treatment,and both systolic and diastolic blood pressure were lower than those before treatment(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups during the treatment(P=0.695).Conclusions The curative effect of sacubitril valsartan sodium is significant on coronary atherosclerotic heart disease combined with CHF,which can effectively improve cardiac function of patients.In addition,it can significantly regulate blood pressure,so it is necessary to strengthen monitoring for hypotension patients.