沙库巴曲缬沙坦联合美托洛尔治疗老年慢性心力衰竭患者的临床疗效

Clinical efficacy of sacubitril valsartan combined with metoprolol in the treatment of elderly patients with chronic heart failure

目的观察沙库巴曲缬沙坦联合美托洛尔治疗老年慢性心力衰竭(CHF)患者的临床疗效。方法选取2021年1月—2022年12月喀什地区第一人民医院收治的老年CHF患者90例,按随机数字表法分为美托洛尔组与联合治疗组,各45例。美托洛尔组予以酒石酸美托洛尔片,联合治疗组在美托洛尔组基础上给予沙库巴曲缬沙坦钠片,2组均治疗3个月。比较2组临床疗效,治疗前与治疗3个月后心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)与左心室舒张末期内径(LVEDD)]、血管内皮功能指标[一氧化氮(NO)、一氧化氮合酶(NOS)、内皮素(ET)]、N末端脑钠肽前体(NT-proBNP)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD),不良反应。结果联合治疗组总有效率高于美托洛尔组(95.56%vs.80.00%,χ^(2)=5.075,P=0.024)。治疗3个月后,2组LVEF高于治疗前,LVESD、LVEDD小于治疗前,且联合治疗组升高/缩小幅度大于美托洛尔组(P<0.01);2组血清NO、NOS水平高于治疗前,血清ET水平低于治疗前,且联合治疗组升高/降低幅度大于美托洛尔组(P<0.01);2组血清NT-proBNP、AngⅡ、ALD水平低于治疗前,且联合治疗组低于美托洛尔组(P<0.01)。联合治疗组与美托洛尔组不良反应总发生率比较,差异无统计学意义(4.44%vs.6.67%,P=1.000)。结论沙库巴曲缬沙坦联合美托洛尔治疗老年CHF患者的临床疗效确切,可更有效地改善患者心功能及血管内皮功能,提高肾素—血管紧张素—醛固酮系统功能,有助于改善患者预后,且用药安全性较高。

Objective To observe the clinical efficacy of sacubitril valsartan combined with metoprolol in the treatment of elderly patients with CHF.Methods A total of 90 cases of elderly patients with CHF admitted to the Kashi Region First People′s Hospital from January 2021 to December 2022 year were selected,and divided into the metoprolol group and the combined treatment group according to random number table method,with 45 cases in each group.The metoprolol group was given metoprolol tartrate tablets,and the combined treatment group was given sacubitril valsartan soudium tablets on the basis of the metoprolol group,and both groups were treated for 3 months.Clinical efficacy,cardiac function indexes(LVEF,LVESD,LVEDD),vascular endothelial function indexes(NO,NOS,ET),NT-proBNP,AngⅡ,ALD before treatment and after 3 months of treatment,and incidence of adverse reactions were compared between the two groups.Results Total effective rate in the combined treatment group was higher than that in the metoprolol group(95.56%vs.80.00%,χ^(2)=5.075,P=0.024).After 3 months of treatment,LVEF of the two groups was higher than that before treatment,LVESD and LVEDD were smaller than those before treatment,and the increase/decrease magnitude of the combined treatment group were greater than those of the metoprolol group(P<0.01);Serum levels of NO and NOS of the two groups were higher than those before treatment,and serum ET level of the two groups lower than that before treatment,and the increase/decrease magnitude of the combined treatment group were greater than those of the metoprolol group(P<0.01);Serum levels of NT-proBNP,AngⅡ,ALD of the two groups were lower than those before treatment,and the combined treatment group were lower than those of the metoprolol group(P<0.01).There was no statistically significant difference in the tota l incidence of adverse reactions between the combined treatment group and the metoprolol group(4.44%vs.6.67%,P=1.000).Conclusion The clinical efficacy of sacubitril valsartan combined with metoprolol in the treatment of elderly patients with CHF is precise,which can more effectively improve the cardiac function and vascular endothelial function of patients,promote the renin-angiotensin-aldosterone system function,and help to improve the prognosis of patients,and with higher safety.