沙库巴曲缬沙坦对心力衰竭合并室性心律失常患者左室重构、心率变异性及QT离散度的影响

Effect of Sacubitril Valsartan on Left Ventricular Remodeling,Heart Rate Variability and QT Dispersion in Patients with Heart Failure Complicated with Ventricular Arrhythmias

目的:探讨心力衰竭合并室性心律失常患者采取沙库巴曲缬沙坦治疗对左室重构、心率变异性、QT离散度的影响。方法:选取2021年1月—2022年12月福建中医药大学附属第二人民医院收治的80例心力衰竭合并室性心律失常患者为研究对象。根据随机数表法将患者分为研究组与对照组,各40例。两组均采用常规抗心力衰竭药物治疗,对照组应用贝那普利治疗,若应用贝那普利出现干咳及无法耐受患者给予厄贝沙坦治疗,观察组应用沙库巴曲缬沙坦治疗,两组均治疗12周。比较两组治疗前、治疗12周左室重构、心率变异性、QT离散度指标。结果:治疗12周,两组左室射血分数(left ventricular ejection fraction,LVEF)高于治疗前,左室收缩末期内径(left ventricular end-systolic diameter,LVESD)、左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)低于治疗前,且观察组优于对照组,差异有统计学意义(P<0.05)。治疗12周,两组24 h内全部窦性心搏R-R间期标准差(standard deviation of all R-R intervals for all sinus beats within 24 h,SDNN)、全程每5分钟时间段R-R间期平均值的标准差(standard deviation of the average of R-R intervals for all 5-minute segments,SDANN)、相邻R-R间期差的均方根(root mean square of successive differences between adjacent R-R intervals,RMSSD)、相邻R-R间期差≥50 ms的百分数(percentage of successive R-R interval differences greater than or equal to50 milliseconds,pNN50)高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗12周,两组QT间期离散度(QT interval dispersion,QTd)、校正QT间期离散度(QT interval corrected dispersion,QTcd)低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论:沙库巴曲缬沙坦治疗心力衰竭合并室性心律失常患者,可以抑制左室重构,改善心率变异性及QT离散度。

Objective:To investigate the effect of Sacubitril Valsartan therapy on left ventricular remodeling,heart rate variability and QT dispersion in patients with heart failure complicated with ventricular arrhythmia.Method:From January 2021 to December 2022,80 patients with heart failure combined with ventricular arrhythmia who admitted to the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine were selected as the study objects,the patients were divided into the observation group and the control group according to the random number table method,with 40 cases in each group.Two groups were treated with conventional anti-heart failure drugs,the control group was treated with Benazepril,if patients with dry cough and intolerance to Benazepril were treated with Irbesartan,the observation group was treated with Sacubitril Valsartan,two groups were treated for 12 weeks.The left ventricular remodeling,heart rate variability and QT dispersion indexes before and after 12 weeks of treatment were compared between two groups.Result:After 12 weeks of treatment,the left ventricular ejection fraction(LVEF)in two groups were higher than those before treatment,and the left ventricular end-systolic diameter(LVESD)and left ventricular end-diastolic diameter(LVEDD)in two groups were lower than those before treatment,and which in the observation group were better than those in the control group,the differences were statistically significant(P<0.05).After 12 weeks of treatment,standard deviation of all R-R intervals for all sinus beats within 24 h(SDNN),standard deviation of the average of R-R intervals for all 5-minute segments(SDANN),root mean square of successive differences between adjacent R-R intervals(RMSSD),percentage of successive R-R interval differences greater than or equal to 50 milliseconds(pNN50)in two groups were higher than before treatment,and the indexes in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).After 12 weeks of treatment,the QT interval dispersion(QTd)and QT interval corrected dispersion(QTcd)in two groups were lower than which before treatment,and which in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Sacubitril Valsartan can inhibit left ventricular remodeling and improve heart rate variability and QT dispersion in patients with heart failure complicated with ventricular arrhythmia.