伊伐布雷定联合沙库巴曲缬沙坦治疗低血压状态下HFrEF患者的效果观察

Observation on effect of combination of ivabradine and sacubitril valsartan on HFrEF patients with hypotension

目的 观察伊伐布雷定联合沙库巴曲缬沙坦治疗低血压状态下射血分数降低的心力衰竭(HFrEF)患者的效果。方法 118例低血压状态下HFrEF患者,随机分为观察组(60例)和对照组(58例)。对照组患者口服沙库巴曲缬沙坦治疗,观察组患者在对照组基础上加用伊伐布雷定治疗。比较两组患者的心功能指标[心率、左心射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)、6 min步行距离(6MWT)],炎症因子[白细胞介素-1(IL-1)、白细胞介素-6(IL-6)]水平,生活质量评分,低血压发生情况。结果 观察组心率、LVEF、NT-pro BNP、6MWT分别为(57.36±11.24)次/min、(46.32±5.67)%、(1137.68±462.35)ng/L、(586.32±48.76)m,对照组分别为(64.28±10.62)次/min、(42.62±5.18)%、(1628.64±473.54)ng/L、(506.37±46.82)m。治疗后,观察组患者的心率、NT-proBNP水平比对照组明显更低,同时LVEF比对照组明显更高, 6MWT比对照组明显更长,差异有统计学意义(P<0.05)。观察组IL-1、IL-6分别为(101.26±12.58)、(89.26±7.32)pg/ml,对照组分别为(106.53±13.54)、(101.65±8.05)pg/ml,观察组患者的IL-1、IL-6水平比对照组显著低,差异有统计学意义(P<0.05)。观察组患者情感功能、社会功能、身体功能、认知功能、角色功能方面的生活质量评分分别为(62.56±6.23)、(52.21±4.62)、(52.16±7.26)、(58.69±5.01)、(50.28±8.06)分,均明显高于对照组的(42.62±5.16)、(43.52±5.06)、(46.58±7.02)、(46.32±4.98)、(41.32±7.85)分,差异有统计学意义(P<0.05)。观察组患者发生低血压5例(8.33%),显著少于对照组的18例(31.03%),差异有统计学意义(P<0.05)。结论 伊伐布雷定联合沙库巴曲缬沙坦治疗低血压状态下HFrEF患者,可以显著减轻患者的心力衰竭症状,减少炎性损害,并且增加患者的日常活动水平,而且比较安全可靠,可以在临床推广使用。

Objective To observe the effect of combination of ivabradine and sacubitril valsartan on heart failure with reduced ejection fraction(HFrEF)patients with hypotension.Methods A total of 118 HFrEF patients with hypotension were randomly divided into an observation group(60 cases)and a control group(58 cases).The control group was given oral sacubitril valsartan,and the observation group was given oral ivabradine on the basis of the control group.Comparison was made on cardiac function indicators[heart rate,left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP),6-min walking test(6MWT),interleukin-1(IL-1)and interleukin-6(IL-6)]levels,quality of life score,and occurrence of hypotension between the two groups.Results The heart rate,LVEF,NT-proBNP and 6MWT of the observation group were(57.36±11.24)beats/min,(46.32±5.67)%,(1137.68±462.35)ng/L and(586.32±48.76)m,respectively.Those of the control group were(64.28±10.62)beats/min,(42.62±5.18)%,(1628.64±473.54)ng/L and(506.37±46.82)m,respectively.After treatment,the heart rate and NT-proBNP level of patients in the observation group were significantly lower than those in the control group,while the LVEF was significantly higher than that in the control group,and the 6MWT was significantly longer than that in the control group.The difference was statistically significant(P<0.05).The levels of IL-1 and IL-6 in the observation group were(101.26±12.58)and(89.26±7.32)pg/ml,respectively,while those in the control group were(106.53±13.54)and(101.65±8.05)pg/ml,respectively.The levels of IL-1 and IL-6 in the observation group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The quality of life scores of emotional function,social function,physical function,cognitive function and role function in the observation group were(62.56±6.23),(52.21±4.62),(52.16±7.26),(58.69±5.01)and(50.28±8.06)points,which were significantly higher than(42.62±5.16),(43.52±5.06),(46.58±7.02),(46.32±4.98)and(41.32±7.85)points in the control group,and the difference was statistically significant(P<0.05).Hypotension occurred in 5 patients(8.33%)in the observation group,which was significantly less than 18 patients(31.03%)in the control group,and the difference was statistically significant(P<0.05).Conclusion Treatment of HFrEF patients with hypotension by combining ivabradine and sacubitril valsartan can significantly relieve the symptoms of heart failure,reduce inflammatory damage,and increase the level of daily activity,and more safe and reliable,which can be promoted in clinical practice.