沙库巴曲缬沙坦钠治疗慢性心力衰竭的临床效果及不良反应分析

Analysis of clinical effect and adverse reaction of sacubitril valsartan sodium in the treatment of chronic heart failure

目的研究慢性心力衰竭(CHF)应用沙库巴曲缬沙坦钠治疗的效果及不良反应。方法84例CHF患者,按随机数字表法分为对照组和治疗组,每组42例。所有患者均给予常规对症支持治疗,在此基础上对照组给予缬沙坦联合琥珀酸美托洛尔治疗,治疗组给予沙库巴曲缬沙坦钠联合琥珀酸美托洛尔治疗。比较两组患者治疗效果、不良反应(睡眠障碍、血管性水肿、上腹不适、乏力)发生情况以及治疗前后心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、每搏输出量(SV)]、血清学指标[N-末端B型脑钠肽前体(NT-proBNP)、细胞间粘附分子-1(ICAM-1)]。结果治疗组总有效率92.86%高于对照组的69.05%,差异具有统计学意义(P<0.05)。治疗后,两组LVEF、SV高于治疗前,LVESD、LVEDD低于治疗前,且治疗组患者LVEF(51.14±5.23)%、SV(57.22±4.12)ml高于对照组的(41.29±4.36)%、(50.45±3.16)ml,LVESD(45.12±2.54)mm、LVEDD(58.33±2.09)mm低于对照组的(48.59±2.77)、(62.22±3.05)mm,差异均具有统计学意义(P<0.05)。治疗后,两组患者NT-proBNP、ICAM-1水平均低于治疗前,且治疗组患者NT-proBNP(578.23±80.44)ng/L、ICAM-1(32.21±2.49)ng/L均低于对照组的(892.58±84.91)、(44.26±3.27)ng/L,差异均具有统计学意义(P<0.05)。治疗组不良反应发生率7.14%低于对照组的33.33%,差异具有统计学意义(χ^(2)=8.924,P<0.05)。结论CHF应用沙库巴曲缬沙坦钠治疗有利于改善心功能,下调NT-proBNP、ICAM-1表达,且不良反应少。

Objective To study the effect and adverse reaction of sacubitril valsartan sodium in the treatment of chronic heart failure(CHF).Methods A total of 84 patients with CHF were divided into a control group and a treatment group by random numerical table,with 42 cases in each group.All patients were given conventional symptomatic supportive treatment.On this basis,the control group was given valsartan combined with metoprolol succinate,and the treatment group was given sacubactril valsartan sodium combined with metoprolol succinate.Both groups were compared in terms of therapeutic effect,occurrence of adverse reactions(sleep disorders,angioedema,upper abdominal discomfort,fatigue),cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),stroke volume(SV)]and serological indexes[N-terminal pro-B-type natriuretic peptide(NT-proBNP),intercellular adhesion molecule-1(ICAM-1)]before and after treatment.Results The total effective rate of the treatment group was 92.86%,which was higher than that of 69.05%of the control group,and the difference was statistically significant(P<0.05).After treatment,LVEF and SV in both groups were higher than those before treatment in this group,and LVESD and LVEDD were lower than those before treatment in this group;LVEF of(51.14±5.23)%and SV of(57.22±4.12)ml in the treatment group were higher than those of(41.29±4.36)%and(50.45±3.16)ml in the control group;LVESD of(45.12±2.54)mm and LVEDD of(58.33±2.09)mm in the treatment group were lower than those of(48.59±2.77)and(62.22±3.05)mm in the control group;the differences were statistically significant(P<0.05).After treatment,the levels of NT-proBNP and ICAM-1 in both groups were lower than those before treatment in this group;NT-proBNP of(578.23±80.44)ng/L and ICAM-1 of(32.21±2.49)ng/L in the treatment group were lower than those of(892.58±84.91)and(44.26±3.27)ng/L in the control group;the differences were statistically significant(P<0.05).The incidence of adverse reactions in the treatment group was 7.14%,which was lower than that of 33.33%in the control group,and the difference was statistically significant(χ^(2)=8.924,P<0.05).Conclusion The treatment of CHF with sacubitril valsartan sodium is beneficial to improve cardiac function,down-regulate the expression of NT-proBNP and ICAM-1,and has few adverse reactions.