高压氧联合沙库巴曲缬沙坦治疗慢性心力衰竭的临床研究

Clinical study of hyperbaric oxygen combined with angiotensin receptor-neprilysin inhibitors in the treatment of chronic heart failure

目的:探讨高压氧联合沙库巴曲缬沙坦(Angiotensin receptor neprilysin inhibitor,ARNI)治疗对慢性心力衰竭(Chronic heart failure,CHF)的影响。方法:选择2018年10月至2020年12月医院112例CHF患者作为研究对象,随机数字表法分为观察组和对照组(n=56)。观察组实施常规治疗+高压氧联合ARNI治疗,对照组实施常规治疗+ARNI 50 mg·次-1,2次·d^(-1)。治疗前、治疗3 m后,使用彩色多普勒超声仪检查患者的心功能,包括左心室舒张末期内径(Left ventricular end diastolic dimension,LVEDD)、左心室射血分数(Left ventricular ejection fractions,LVEF)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD);以全自动生化仪测定心肌损伤标志物:N末端B型利钠肽原(N-terminal-pro-B-type natriuretic peptide,NT-pro BNP)、心肌肌钙蛋白I(cardiac troporlin I,cTnI)水平;使用散射比浊法检测C反应蛋白(C-reactive protein,CRP)水平,采用电化学发光法测定肿瘤坏死因子α(Tumor necrosis fctor-alpha,TNF-α)、白细胞介素6(Interleukin-6,IL-6)水平;并比较治疗前、治疗3 m后患者6min步行试验(6-minute walk test,6MWT)结果。结果:治疗3m,观察组LVEDd、LVESD低于对照组,LVEF高于对照组(P<0.05);观察组NT-Pro BNP、cTnI低于对照组(P<0.05);观察组IL-6、CRP、TNF-α低于对照组(P<0.05);观察组6MWT长于对照组(P<0.05)。结论:高压氧联合ARNI治疗能改善心功能和心肺功能,减轻心肌损伤、炎症反应。

Objective:To investigate the effect of hyperbaric oxygen combined with angiotensin receptor-neprilysin inhibitors(ARNI)in the treatment of chronic heart failure(CHF).Methods:A total of 112 patients with CHF in the hospital from October 2018 to December 2020 were selected as the research subjects,random number table method was used to divide into two groups,56 cases in each group.The observation group was treated with routine treatment+hyperbaric oxygen combined with ARNI,and the control group was treated with routine treatment+ARNI,and the dose of ARNI was 50 mg·time-1,2 times·d^(-1).Before treatment and 3 m after treatment,cardiac functions including left ventricular end diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)were examined by color Doppler ultrasound.Myocardial injury marker levels,such as N-terminal-pro-B-type natriuretic peptide(NT-pro BNP),cardiac troponin I(cTnI)were detected by automatic biochemical analyzer before treatment and 3 months after treatment.C-reactive protein(CRP)was measured by nephelometry before and 3 m after treatment.Tumor necrosis factor-alpha(TNF-α)and interleukin-6(IL-6)levels were measured by electrochemiluminescence before and 3 m after treatment.The results of 6-minute walk test(6MWT)were compared between the two groups before treatment and 3 m after treatment.Results:After treatment,LVEDd and LVESD in the observation group were lower than those in the control group,and LVEF was higher than that in the control group(P<0.05).NT-Pro BNP and cTnI levels in the observation group were lower than those in the control group(P<0.05).The levels of IL-6,CRP and TNF-αlevels in the observation group were lower than those in the control group(P<0.05).6MWT in the observation group was longer than that in the control group(P<0.05).Conclusion:Hyperbaric oxygen combined with ARNI can improve cardiac function and cardiopulmonary function,reduce myocardial injury and inflammatory reaction.