沙库巴曲缬沙坦对AMI急诊PCI术后射血分数保留型心力衰竭患者的疗效及对心血管事件的影响

Efficacy of shakubaqu valsartan in patients with heart failure with preserved ejection fraction after emergency PCI for AMI and the effect on major cardiovascular events

目的探讨沙库巴曲缬沙坦对急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)术后合并射血分数保留型心力衰竭(HFpEF)患者的疗效及对主要心血管事件(MACE)的影响。方法选取2021年1月至2023年1月于芜湖市第一人民医院收治的60例AMI急诊PCI术后合并HFpEF患者作为研究对象,按数字表法随机分为观察组和对照组,每组各30例,对照组在常规治疗基础上应用缬沙坦,观察组在常规基础上应用沙库巴曲缬沙坦。比较两组治疗前后6 min步行距离(6MWD)、超声心动图指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室后壁厚度(LVPWT)、左心房内径(LAD)及血流峰值速度比(E/A值)]、心率(HR)、舒张压(DBP)、收缩压(SBP)及N末端脑钠肽前体(NT-proBNP)水平。观察两组临床疗效及MACE的发生情况。结果观察组治疗总有效率(93.33%)高于对照组(73.33%),(P<0.05);治疗后两组6MWD较治疗前升高,且观察组6MWD高于对照组(P<0.05);治疗后两组NT-proBNP较治疗前降低,且观察组NT-proBNP低于对照组(P<0.05);两组治疗前后LVEDD、LVESD、LVPWT及LAD指标比较均无统计学差异(P>0.05);治疗后两组LVEF、E/A比值高于治疗前,观察组E/A比值高于对照组(P<0.05);治疗后两组LVEF比较无统计学差异(P>0.05);治疗后两组HR、SBP、DBP均低于治疗前(P<0.05),治疗后两组间比较差异均无统计学差异(P>0.05);观察组MACE发生率(3.33%)较对照组(26.67%)降低,(P<0.05)。结论沙库巴曲缬沙坦治疗AMI急诊PCI术后合并HFpEF患者疗效显著,能提高活动耐力及心功能,降低心率、血压及NT-proBNP水平,改善LVEF和心室舒张功能,降低MACE发生率。

Objective To explore the efficacy and impact on major cardiovascular events(MACE)of shakubaqu valsartan in patients with combined heart failure with preserved ejection fraction(HFpEF)after acute myocardial infarction(AMI)emergency percutaneous coronary intervention(PCI).Methods Sixty patients with combined HFpEF after emergency PCI for AMI admitted to our hospital from January 2021 to January 2023 were selected for the study.They were divided into observation and control groups using the random number table method,with 30 cases in each group.In the control group,valsartan was applied based on conventional treatment,while in the observation group,shakubaqu valsartan was applied based on conventional.The 6 min walking distance(6MWD),echocardiographic indices[left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular posterior wall thickness(LVPWT),left atrial internal diameter(LAD)and peak flow velocity ratio(E/A value)],heart rate,diastolic blood pressure,systolic blood pressure,and N-terminal pro-brain natriuretic peptide(NT-proBNP)level were compared between the two groups before and after treatment.The clinical efficacy and the occurrence of MACE were observed in the two groups.Results The total effective rate of treatment in the observation group(93.33%)was higher than that in the control group(73.33%),(P<0.05).6MWD increased in both groups after treatment,and 6MWD in the observation group was higher than in the control group(P<0.05).NT-proBNP decreased in both groups after treatment compared with that before treatment,and NT-proBNP in the observation group was lower than in the control group(P<0.05).There were no statistical differences in LVEDD,LVESD,LVPWT and LAD indexes between the two groups before and after treatment(P>0.05).LVEF and E/A ratios were higher in the two groups after treatment than before,and the E/A ratio was higher in the observation group than in the control group(P<0.05).There was no statistical difference in LVEF between the two groups after treatment(P>0.05).After treatment,the two group’s heart rate,systolic blood pressure,and diastolic blood pressure were lower than before treatment(P<0.05).However,there was no statistically significant difference between the two groups after treatment(P>0.05).The incidence of MACE in the observation group(3.33%)was lower than that in the control group(26.67%),(P<0.05).Conclusion The efficacy of shakubaqu valsartan in treating patients with combined HFpEF after AMI emergency PCI is significant,improving activity tolerance and cardiac function,reducing heart rate,blood pressure,and NT-proBNP level,improving LVEF and ventricular diastolic function,and reducing the incidence of MACE.