沙库巴曲缬沙坦治疗慢性心力衰竭合并高血压高龄患者的效果及安全性

Efficacy and safety of sacubitril valsartan sodium in the treatment of elderly patients with chronic heart failure complicated with hypertension

目的探讨沙库巴曲缬沙坦治疗慢性心力衰竭合并高血压高龄患者的临床疗效及安全性。方法选取2019年6月至2021年3月辽宁省金秋医院收治的慢性心力衰竭合并高血压的高龄患者112例为研究对象进行回顾性研究,根据临床用药的不同分组,对照组(n=56)给予常规抗心力衰竭药物治疗,观察组(n=56)将常规抗心力衰竭药物治疗方案中的血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)替换为沙库巴曲缬沙坦钠治疗;两组均治疗3个月并随访3个月。比较两组治疗前后临床治疗有效率、心力衰竭指标[氨基末端脑钠肽前体(NT-pro-BNP)]、心功能相关指标、血压指标、血清离子、肝肾功能指标,并记录治疗期间不良反应的发生情况及随访期间预后情况。结果观察组的临床治疗总有效率为91.07%,明显高于对照组的69.64%,差异有统计学意义(χ^(2)=8.145,P<0.05)。治疗后,两组NT-pro-BNP均降低,观察组下降更明显(P<0.05);两组左心室射血分数(LVEF)、每搏输出量(SV)水平均升高,观察组明显高于对照组(P<0.05);两组左心室舒张末期内径(LVEDD)水平降低,观察组明显低于对照组(P<0.05)。两组治疗后收缩压、舒张压均下降,且观察组明显低于对照组(P<0.05);两组心率下降,但组间差异无统计学意义(P>0.05)。治疗前后两组患者的血清离子及肝肾功能相关指标比较,差异无统计学意义(P>0.05)。观察组不良反应总发生率为21.43%,与对照组的26.79%比较,差异无统计学意义(χ^(2)=0.439,P>0.05)。随访期间,观察组因心力衰竭和/或高血压再入院率为48.21%,明显低于对照组的67.86%(χ2=4.436,P<0.05)。结论采用沙库巴曲缬沙坦治疗慢性心力衰竭合并高血压高龄患者临床疗效显著,可有效改善心功能、降低血压,降低再入院率,且安全性较好。

Objective To explore the clinical efficacy and safety of sacubitril valsartan sodium in the treatment of elderly patients with chronic heart failure complicated with hypertension.Methods A retrospective study was conducted to collect 112 elderly patients with chronic heart failure complicated with hypertension admitted to Jinqiu Hospital of Liaoning Province from June 2019 to March 2021.They were divided into two groups according to different clinical drugs.The control group(n=56)received conventional anti-heart failure drugs,while the observation group(n=56)received sacubitril valsartan sodium instead of angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)in the anti-heart failure therapy.Both groups were treated for 3 months and followed up for 3 months.The clinical effective rates,heart failure indicators(N-terminal pro-brain natriuretic peptide[NT-pro-BNP]),cardiac function-related indicators,blood pressure indicators,serum ion and liver and kidney function indicators before and after treatm ent were compared between the two groups,and the incidences of adverse reactions during treatment and the prognosis during follow-up were recorded.Results The total effective rate of clinical treatment in the observation group(91.07%)was significantly higher than that in the control group(69.64%),with statistically significant differences(χ2=8.145,P<0.05).After treatment,NT-pro-BNP in two groups were decreased,the decrease in the observation group was more significant(P<0.05).The levels of left ventricular ejection fraction(LVEF)and stroke volume(SV)in two groups were increased,and were significantly higher in the observation group than those in the control group(P<0.05).The level of left ventricular end diastolic diameter(LVEDD)in two groups were decreased,and was significantly lower in the observation group than in the control group(P<0.05).After treatment,systolic blood pressure and diastolic blood pressure in two groups were decreased,and were significantly lower in the observation group than those in the control group(P<0.05).Heart rate in two groups were decreased,but there was no significant difference between the two groups(P>0.05).Before and after treatment,there were no significant changes in serum ions and related indicators of liver and kidney function in two groups(P>0.05).The total incidence of adverse reactions in the observation group was 21.43%,and there was no significant difference compared with 26.79%in the control group(χ^(2)=0.439,P>0.05).During the follow-up period,the readmission rate due to heart failure and/or hypertension of the observation group(48.21%)was significantly lower than that of the control group(67.86%)(χ^(2)=4.436,P<0.05).Conclusion Sacubitril valsartan sodium is effective in the treatment of elderly patients with chronic heart failure complicated with hypertension,which can effectively improve heart function,lower blood pressure and reduce readmission rate,with good safety.