STEMI合并心衰患者急诊PCI术后早期应用沙库巴曲缬沙坦对心功能和左心室重构的影响

Effect of Early Sacubactril Valsartan on Cardiac Function and Left Ventricular Remodeling After Emergency PCI in Patients with Heart Failure After STEMI

目的探究STEMI合并心衰患者急诊PCI术后早期应用沙库巴曲缬沙坦对心功能和左心室重构的影响。方法选取2021年10月至2022年4月在我院心内科接受PCI治疗的130例STEMI合并心衰患者,按照随机数字表法分为对照组和观察组,每组各65例。PCI术后24 h内,对照组给予依那普利片治疗,观察组给予沙库巴曲缬沙坦治疗。观察两组患者PCI术后即刻及术后4周、24周血清N端B型脑钠肽前体(NT-proBNP)水平;左室收缩末期容积(LVESV)、左室射血分数(LVEF)和左室舒张末期容积(LVEDV)等心功能指标。术后4周、24周6分钟步行试验。两组不良心血管事件(MACE);死亡、再梗死、门诊心衰或心衰住院、恶性心律失常或中风等预后情况;不良反应。结果术后4周、24周,观察组血清NT-proBNP较对照组降低(P<0.05)。术后4周、24周,观察组LVEF较对照组升高(P<0.05),观察组LVESV和LVEDV较对照组降低(P<0.05)。观察组术后4周、24周的6分钟步行试验距离较对照组增多(P<0.05)。观察组心衰或心衰住院、恶性心律失常、死亡发生率低于对照组(P<0.05)。两组再梗死、中风发生率及治疗期间不良反应发生率差异无统计学意义(P>0.05)。结论沙库巴曲缬沙坦可改善行PCI的STEMI合并心衰患者的左室收缩功能,抑制左心室重构,降低NT-proBNP水平。

Objective To explore the effects of early application of Sacubactril valsartan on cardiac function and left ventricular remodeling after emergency PCI in patients with heart failure after STEMI.Methods A total of 130 STEMI patients with heart failure who received PCI in the Department of Cardiovascular of our Hospital from October 2021 to April 2022 were selected and divided into control group and observation group according to random number table method,with 65 cases in each group.Within 24 h after PCI,the control group was treated with enalapril tablets,and the observation group was treated with Sacubattril valsartan.The serum N-terminal B-type brain natriuretic peptide(NT-proBNP)levels were observed immediately after PCI and at 4 and 24 weeks after PCI.Left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV)and other cardiac function indicators.6-minute walking test at 4 and 24 weeks after surgery.Two groups of adverse cardiovascular events(MACE);Prognosis of death,reinfarction,outpatient heart failure or hospitalization for heart failure,malignant arrhythmia or stroke;An adverse reaction.Results Serum NT-proBNP in the observation group was lower than that in the control group at 4 and 24 weeks after surgery(P<0.05).At 4 and 24 weeks after operation,LVEF in observation group was higher than that in control group(P<0.05),LVESV and LVEDV in observation group were lower than that in control group(P<0.05).The 6-minute walking test distance of the observation group increased at 4 weeks and 24 weeks after surgery compared with the control group(P<0.05).The incidence of heart failure or heart failure hospitalization,malignant arrhythmia and death in observation group was lower than that in control group(P<0.05).The incidence of reinfarction,stroke and the incidence of adverse reactions during treatment were not different between the two groups(P>0.05).Conclusions Sakubactril valsartan can improve left ventricular systolic function,inhibit left ventricular remodeling and reduce NT-proBNP level in STEMI patients with heart failure after PCI.