注射用益气复脉(冻干)联合沙库巴曲缬沙坦治疗慢性心力衰竭疗效及对患者hs-cTnT、NT-proBNP及左心室功能的影响

Effects of Yiqi Fumai Lyophilized Injection combined with sacubitril/valsartan on chronic heart failure and its effect on hs-cTnT,NT-proBNP and left ventricular function of patients

目的 探讨注射用益气复脉(冻干)联合沙库巴曲缬沙坦治疗慢性心力衰竭的疗效及对患者高灵敏度肌钙蛋白(hs-cTnT)、氨基端前心钠肽(NT-proBNP)及左心室功能的影响。方法 选取2020年1月-2022年12月东营市第五人民医院收治的慢性心力衰竭患者200例为研究对象,根据患者治疗方案不同分为对照组和试验组,每组各100例。对照组在常规治疗基础上采用沙库巴曲缬沙坦钠片治疗,每天2次,初始剂量每次50 mg,后根据患者病情调整剂量,每天最多不超过200 mg。试验组在对照组治疗基础上,联用注射用益气复脉(冻干),5.2 g加入葡萄糖注射液250 m L中,静脉滴注,每天1次。两组均接受持续2周的治疗。统计并比较两组的治疗效果,分别于治疗前后测定血清hs-cTnT、NT-proBNP和转化生长因子β1(TGF-β1)水平,分别于治疗前后行超声心动图检查,检测患者的左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室短轴缩短率(FS)。观察治疗期间两组患者低血压、皮疹、高血钾症、血管性水肿等不良反应的发生情况。结果 试验组治疗总有效率为98.00%,显著高于对照组的88.00%(P<0.05)。治疗前,两组患者血清hs-cTnT、NT-proBNP、TGF-β1水平比较,差异无统计学意义(P>0.05);治疗后,两组患者血清hs-cTnT、NT-proBNP、TGF-β1水平均较同组治疗前显著降低,且试验组各指标水平均显著低于对照组(P<0.05)。治疗前,两组患者左心室功能指标LVESD、LVEDD、LVEF、FS比较,差异均无统计学意义(P>0.05);治疗后,两组患者LVESD、LVEDD均较本组治疗前显著降低(P<0.05),而LVEF及FS均较本组治疗前显著升高(P<0.05),且试验组各指标改善程度均优于对照组(P<0.05)。试验组发生不良反应3例,总发生率为3.00%,显著低于对照组的15.00%(P<0.05)。结论 注射用益气复脉(冻干)联合沙库巴曲缬沙坦治疗慢性心力衰竭,可改善患者左心室功能,降低心肌受损;还可降低hs-cTnT、NT-proBNP水平,减少药物不良反应,增强临床疗效。

Objective To investigate the efficacy of Yiqi Fumai Lyophilized Injection(YQFM)combined with sacubitril/valsartan in the treatment of chronic heart failure and the effects on high-sensitivity troponin(hs-cTnT),N-terminal pro brain natriuretic peptide(NT-proBNP)and left ventricular function in patients with chronic heart failure.Methods A total of 200 patients with chronic heart failure admitted to the Fifth People's Hospital of Dongying City from January 2020 to December 2022 were selected as the research objects.According to the different treatment schemes of patients,they were divided into the control group and the experimental group,with 100 cases in each group.On the basis of routine treatment,patients in the control group were treated with Sacubitril Valsartan Sodium Tablets,which was taken twice a day on an empty stomach or with food,with an initial dose of 50 mg each time.After that, the dosage was adjusted according to the patient's condition, with a maximum of 200 mg per day. On the basis oftreatment in the control group, patients in the experimental group received a combination of YQFM, and 5.2 g of YQFM was addedto 250 mL of Glucose Injection, intravenous drip once a day. Both groups received treatment lasting for two weeks. The therapeuticeffects of the two groups were counted and compared. Serum hs-cTnT, NT-proBNP and transforming growth factor β1 (TGF- β1)were measured before and after treatment. Horizontal echocardiography was performed before and after treatment to measure the leftventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), LVEF, and left ventricular short axisshortening rate (FS) of the patients. The incidence of adverse reactions such as hypotension, rash, hyperkalemia and angioedema inthe two groups were observed during the treatment. Results The total effective rate of the experimental group was 98.00%,significantly higher than the 88.00% of the control group (P < 0.05). Before treatment, the serum hs-cTnT, NT-proBNP, and TGF-β1levels of patients in both groups were measured and there were no statistically significant difference in level comparison betweentwo groups (P > 0.05). After treatment, the serum levels of hs-cTnT, NT-proBNP, and TGF- β1 in both groups of patients weresignificantly lower than before treatment in the same group, and the levels of all indicators in the experimental group weresignificantly lower than those in the control group (P < 0.05). Before treatment, there was no statistically significant difference in leftventricular function indicators LVESD, LVEDD, LVEF, and FS between the two groups of patients (P > 0.05). After treatment,LVESD and LVEDD in both groups of patients were significantly reduced compared to before treatment in the same group (P <0.05), while LVEF and FS were significantly increased compared to before treatment in same group (P < 0.05), and the improvementdegree of all indicators in the experimental group was better than that in the control group (P < 0.05). There were three cases ofadverse reactions in the experimental group, with a total incidence rate of 3.00%, significantly lower than the 15.00% in the controlgroup (P < 0.05). Conclusion YQFM combined with sakubatrox valsartan can improve left ventricular function and reducemyocardial damage in patients with chronic heart failure. On the other hand, it can reduce the levels of hs-cTnT and NT-ProBNP,reduce adverse drug reaction, and enhance clinical efficacy.