沙库巴曲缬沙坦对老年维持性血液透析患者慢性心力衰竭疗效的临床研究

Efficacy of sacubitril/valsartan in treatment of chronic heart failure in elderly patients undergoing maintenance hemodialysis

目的评价沙库巴曲缬沙坦(SV)治疗老年维持性血液透析(MHD)患者慢性心力衰竭的临床疗效及安全性。方法纳入2021年1月至12月在我院肾内科就诊的合并慢性心力衰竭的老年MHD患者82例,根据是否服用SV分为治疗组40例和对照组42例,治疗组服用SV治疗,对照组使用血管紧张素转化酶抑制剂或血管紧张素受体阻滞剂治疗,比较2组血压、N末端B型钠尿肽前体(NT-proBNP)及心脏超声指标左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、LVEF,采用多元有序logistic回归分析疗效的影响因素。结果治疗组治疗后LVEF明显高于对照组,收缩压、舒张压、NT-proBNP、LVEDD、LVESD明显低于对照组(P<0.05)。治疗组总有效率明显高于对照组(92.5%vs 64.3%,P<0.01),心力衰竭再住院率明显低于对照组(10.0%vs 28.6%,P<0.05)。多元有序logistic回归分析显示,应用SV是影响治疗效果的独立因素(OR=2.166,95%CI:1.093~4.293,P=0.027)。2组治疗后高钾血症发生率比较,差异无统计学意义(P>0.05)。结论SV能有效控制合并慢性心力衰竭的老年MHD患者血压,抑制心室重构,改善心脏功能,治疗中应该警惕高钾血症发生。

Objective To investigate the clinical efficacy and safety of SV in the treatment of chronic heart failure in the elderly patients undergoing MHD.Methods A retrospective case-control trial was conducted on 82 elderly patients with chronic heart failure undergoing MHD in our department from January to December,2021.They were divided into SV group(50-200 mg SV,twice a day,n=40)and control group(ACEI or ARB treatment,n=42).Blood pressure,NT-proBNP and cardiac ultrasound indexes,including LVEDD,LVESD,and LVEF were compared between the 2 groups.Multiple ordered logistic regression analysis was used to analyze the influencing factors for treatment efficacy.Results The SV treatment group had notably higher LVEF and lower SBP,DBP,NT-proBNP,LVEDD and LVESD after treatment when compared with the control group(P<0.05).The SV treatment group also had a higher total effective rate(92.5%vs 64.3%,P<0.01)and a lower re-hospitalization rate due to heart failure(10.0%vs 28.6%,P<0.05)than the control group.The results of multiple ordered logistic regression analy-sis showed that the use of SV was an independent influencing factor for treatment efficacy(OR=2.166,95%CI:1.093-4.293,P=0.027).There was no statistical difference in the incidence of hyperkalemia between the 2 groups(P>0.05).Conclusion SV can effectively control blood pressure,inhibit ventricular remodeling and improve cardiac function in elderly MHD patients with chronic heart failure.Clinicinas should be alert to hyperkalemia during the treatment.