沙库巴曲缬沙坦治疗伴慢性射血分数降低心力衰竭的血液透析患者的效果评价

Study on the effect of sacubitril-valsartan in the treatment of hemodialysis patients with chronic heart failure with reduced ejection fraction

目的 探讨沙库巴曲缬沙坦治疗伴慢性射血分数降低心力衰竭(HFrEF)的血液透析(HD)患者的疗效。方法 30例伴慢性HFrEF的HD患者,按照治疗方法不同分为对照组和研究组,每组15例。两组患者均采取常规HD及基础用药治疗,同时,对照组联合贝那普利片治疗,研究组联合沙库巴曲缬沙坦钠片治疗。两组持续用药6个月,比较两组患者治疗前后的左心射血分数(LVEF)、左心室舒张末期内径(LVEDD)、N末端B型利钠肽前体(NT-proBNP)和血钾水平。结果 (1)组内比较:与本组治疗前比较,对照组治疗3、6个月的LVEF升高, LVEDD和NT-proBNP下降(P<0.05);与本组治疗3个月比较,对照组治疗6个月的LVEF、LVEDD、NT-proBNP无差异(P>0.05)。与本组治疗前比较,研究组治疗3、6个月的LVEF升高, LVEDD和NT-proBNP下降(P<0.05);与本组治疗3个月比较,研究组治疗6个月的LVEF、LVEDD无差异(P>0.05),治疗6个月的NT-proBNP下降(P<0.05)。组间比较:研究组治疗3、6个月的LVEF(47.63±5.03)%、(48.17±5.16)%高于对照组的(41.79±4.19)%、(42.28±4.37)%, LVEDD(52.63±3.81)、(51.02±3.49)mm小于对照组的(56.47±4.01)、(55.72±4.13)mm,NT-pro BNP(17916.25±5126.40)、(13152.73±5093.37)pg/ml低于对照组的(24776.63±6609.51)、(23942.45±6393.51)pg/ml(P<0.05)。(2)组内比较:与本组治疗前比较,两组治疗2、4、6个月后血钾无差异(P>0.05)。组间比较:治疗2、4、6个月后,两组血钾水平比较无差异(P>0.05)。结论 沙库巴曲缬沙坦可以用于伴慢性HFrEF的HD患者的心力衰竭治疗,且疗效优于贝那普利,有较高的临床应用价值。

Objective To explore the efficacy of sacubitril-valsartan in the treatment of hemodialysis(HD)patients with chronic heart failure with reduced ejection fraction(HFrEF).Methods A total of 30 hemodialysis patients with chronic HFrEF were allocated into a control group and an experimental group according to different treatment methods,each comprising of 15 patients.Both groups were treated with conventional HD and basic medication.Meanwhile,the control group received benazepril tablets,while the study group was administered sacubitril/valsartan sodium tablets.Both groups underwent continuous medication for 6 months.Both groups were compared in terms of left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),N-terminal pro-B-type natriuretic peptide(NT-proBNP),and blood potassium levels.Results(i)Intragroup comparison:compared with the control group before treatment,LVEF increased,LVEDD and NT-proBNP decreased after 3 and 6 months of treatment(P<0.05).There was no difference in LVEF,LVEDD,and NT-proBNP in the control group at 6 months of treatment compared with this group at 3 months of treatment(P>0.05).LVEF increased and LVEDD and NT-proBNP decreased in the study group at 3 and 6 months of treatment compared with those before treatment in this group(P<0.05).Compared with those at 3 months after treatment,there was no significant change in LVEF and LVEDD in the study group after 6 months of treatment(P>0.05),and the NT-proBNP of the study group decreased after 6 months of treatment(P<0.05).Comparison between groups:LVEF of the study group were(47.63±5.03)%and(48.17±5.16)%after 3 and 6 months of treatment,which were higher than(41.79±4.19)%and(42.28±4.37)%of the control group;LVEDD were(52.63±3.81)and(51.02±3.49)mm,which were smaller than(56.47±4.01)and(55.72±4.13)mm of the control group;NT-proBNP were(17916.25±5126.40)and(13152.73±5093.37)pg/ml,which were lower than(24776.63±6609.51)and(23942.45±6393.51)pg/ml of the control group(P<0.05).(ii)Compared with before treatment,there was no change in blood potassium in the two groups after 2,4 and 6 months of treatment(P>0.05).Comparison between groups:after 2,4 and 6 months of treatment,there was no difference in serum potassium level between the two groups(P>0.05).Conclusion Sacubactril-valsartan can be used in the treatment of heart failure in HD patients with chronic HFrEF,and the efficacy is better than benazepril,which has high clinical application value.