ARNI联合rhBNP治疗急性前壁心肌梗死介入术后心力衰竭疗效分析

目的探讨急性前壁心肌梗死介入术后合并心力衰竭患者早期接受小剂量沙库巴曲缬沙坦(ARNI)联合重组人脑利钠肽(rhBNP)治疗的疗效及安全性。方法选取2019年12月至2021年12月本院收治的急性前壁心肌梗死介入术后合并心力衰竭患者102例,对照组52例,观察组50例。对照组给予双联抗血小板聚集药物、利尿剂、β受体阻滞剂、醛固酮拮抗剂、血管紧张素抑制剂、rhBNP等常规治疗;观察组在对照组基础上,将血管紧张素抑制剂改为沙库巴曲缬沙坦小剂量起始治疗。观察两组患者心功能指标、肾功能、电解质、低血压发生率、生存质量、心衰再入院率等指标变化。结果治疗1周时,两组患者血浆N-末端脑利钠肽水平、心脏彩超心功能相关参数差异无统计学意义(P>0.05);两组不良反应(低血压、肾功能恶化和电解质影响)发生率差异无统计学意义(P>0.05)。随访3个月,两组血浆N-末端脑利钠肽水平、心脏彩超心功能相关参数差异有统计学意义(P<0.05),观察组改善更明显;两组明尼苏达心功能不全生命质量量表评分差异有统计学意义(P<0.05),观察组更低;两组心力衰竭再入院率差异有统计学意义(P<0.05),观察组更少。结论早期应用小剂量沙库巴曲缬沙坦联合rhBNP治疗可显著改善急性前壁心肌梗死介入术后合并心力衰竭患者的心功能,提高生存质量,降低3个月内心力衰竭再入院风险,同时安全性良好。

Objective To investigate the efficacy and safety of early treatment with low-dose Sakubitri/Valsartan combined with recombinant human brain natriuretic peptide in patients with heart failure after acute anterior wall ST-segment elevation myocardial infarction intervention.Methods From December 2019 to December 2021,a total of 102 patients with heart failure after acute anterior myocardial infarction intervention were admitted to Shanghai Putuo District Liqun Hospital for treatment.There were 52 cases in the control group and 50 cases in the observation group.The control group was given conventional treatments such as dual antiplatelet aggregation drugs,diuretics,βblockers,aldosterone antagonists,angiotensin inhibitors,recombinant human brain natriuretic peptides.The observation group changed the angiotensin inhibitor to low-dose Sacubitril/Valsartan on the basis of the control group.The changes in cardiac function index,renal function,electrolyte,hypotension incidence,quality of life,and heart failure readmission rate of the two groups were observed.Results During one week of the treatment,there was no statistically significant difference between the NT-pro BNP levels and cardiac ultrasound function related parameters between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions(hypotension,renal function,and electrolyte effects)between the two groups(P>0.05).After 3 months of follow-up,the differences in NT-proBNP levels and super cardiac function related parameters between the two groups were statistically significant(P<0.05),and the improvement was more obvious in the observation group.There was a statistically significant difference in the score of the quality-of-life scale for cardiac insufficiency between the two groups in Minnesota(P<0.05),and the patients in the observation group were even lower.There was a statistically significant difference in heart failure readmission rates between the two groups(P<0.05),and even fewer in the observation group.Conclusion Early treatment with low-dose Sakubitri/Valsartan combined with recombinant human brain natriuretic peptide can significantly improve the cardiac function of patients with heart failure after acute anterior myocardial infarction intervention,improve the quality of life,reduce the risk of heart failure readmission within 3 months,and have a good safety profile.