沙库巴曲缬沙坦对合并高血压的急性心肌梗死PCI术后患者的疗效分析

Efficacy Analysis of Sacubitril/Valsartan in Patients with Acute Myocardial Infarction Complicated with Hypertension After PCI

目的探究沙库巴曲缬沙坦(ARNI)治疗合并高血压的急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后患者的临床疗效及安全性。方法选取江汉大学附属医院2020年10月至2022年4月符合纳入标准的合并高血压的AMI 24 h内行PCI术后患者124例,以随机数字法分为两组,将采用最大耐受剂量ARNI治疗的64例作为观察组,采用缬沙坦治疗的60例作为对照组,随访26周。比较治疗前、后两组患者左室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、N末端B型钠尿肽前体(NT-proBNP)、平均收缩压(SBP)、平均舒张压(DBP)和平均心率(HR),以及随访期间两组患者的药物不良反应和主要心血管不良事件发生率。结果①与治疗前相比较,两组治疗后LVEDD、NT-ProBNP、平均SBP、平均DBP均显著降低,LVEF显著升高(P<0.05);②与对照组治疗后相比较,观察组治疗后LVEDD、NT-ProBNP、平均SBP均进一步降低,LVEF进一步升高(P<0.05);③两组患者不良反应发生率和主要心血管不良事件差异均无统计学意义(P>0.05)。结论ARNI对合并高血压的急性心肌梗死PCI术后患者在改善左心室重构、心功能保护和降低SBP等方面较缬沙坦更具有优势,且安全性良好。

Objective To investigate the clinical efficacy and safety of sacubitril valsartan(ARNI)in the treatment of patients with acute myocardial infarction(AMI)complicated with hypertension after percutaneous coronary intervention(PCI).Methods A total of 124 patients with AMI complicated with hypertension after PCI in 24 hours from October 2020 to April 2022 in the Affiliated Hospital of Jianghan University were selected and divided into the study group and the control groups according to the random principle.64 cases were treated with maximum tolerable dose of ARNI as the study group,while 60 cases were treated with valsartan as the control group,with a follow-up for 26 weeks.The changes in left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),N-terminal pro-B-type natriuretic peptide(NT-proBNP),mean systolic blood pressure(SBP),mean diastolic blood pressure(DBP)and mean heart rate(HR)before and after the treatment were compared between the two groups.The rates of adverse cardiovascular events and drug adverse reactions were observed during follow-up.Results①LVEDD,NT-ProBNP,the mean SBP,and the mean DBP significantly decreased,and LVEF significantly increased in both groups after the treatment(P<0.05 for all comparisons).②LVEDD,NT-ProBNP,and the mean SBP were significantly lower,and LVEF was evidently higher in the study group than in the control group after the treatment(P<0.05 for all comparisons).③There was no difference in the incidence of adverse reactions and major cardiovascular adverse events between the two groups(P>0.05 for all comparisons).Conclusion ARNI is superior and safe to valsartan in improving left ventricular remodeling,protecting cardiac function,and reducing SBP in patients with AMI complicated with hypertension after PCI.