【摘要】 目的观察沙库巴曲缬沙坦对射血分数降低心衰患者心脏重构及心功能的影响。方法选取射血分数降低的心衰患者120人,按照2018中国心衰指南给予标准心衰治疗,不论患者既往是否服用ACEI/ARB,入院后均给予沙库巴曲缬沙坦治疗,根据血压从可以耐受的最小剂量开始。留取患者基线资料,出院后1个月、3个月、6个月、9个月随访,根据血压逐渐增加沙库巴曲缬沙坦至可耐受的最大剂量。随访期间监测血浆NT-proBNP水平、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左房前后径(LAD),记录患者6min步行试验距离及生活质量量表KCCQ评分,并收集用药期间的不良反应。结果随访9个月,血浆NT-proBNP水平较基线明显降低,随着治疗时间延长,降低越明显(P<0.05);左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左房前后径(LAD)均较基线明显缩小,随着治疗时间延长,缩小越明显(P<0.05);左室射血分数(LVEF)、6min步行试验距离、KCCQ评分较基线明显增加,随着治疗时间延长,增加越明显(P<0.05);肾小球滤过率(eGFR)及血清K~+较基线无明显改变。结论沙库巴曲缬沙坦能改善射血分数降低心衰患者的心功能及抑制心脏重构,并随着治疗时间延长效果越明显,且安全性良好。更多还原

【Abstract】 Objective To observe the effect of sacubitril/valsartan on cardiac function and cardiac remodeling in heart failure with reduced eiection fraction(HFrEF) patients. Methods 120 patients with heart failure with reduced ejection fraction were selected and given standard heart failure treatment according to the 2018 Chinese heart failure guidelines. Regardless of whether the patients had taken ACEI/ARB in the past, they were treated with sakubatravalsartan after admission, starting from the minimum tolerable dose according to the blood pressure. The patients were followed up for 1 month, 3 months, 6 months and 9 months after discharge. During the follow-up period, plasma NT proBNP level, left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDd), left ventricular end systolic diameter(LVESD), left atrial anteroposterior diameter(LAD) were monitored. The 6-minute walking distance and the KCCQ score of quality of life scale were recorded, and the adverse reactions were collected. Results After 9 months of follow-up, the level of plasma NT proBNP was significantly lower than that of baseline, and the decrease was more obvious with the prolongation of treatment time(P<0.05). Left ventricular end diastolic diameter(LVEDd), left ventricular end systolic diameter(LVESD) and left atrial anteroposterior diameter(LAD) were significantly reduced compared with baseline, and the more obvious the reduction was with the prolongation of treatment time(P<0.05). Left ventricular ejection fraction(LVEF), 6-minute walking distance and KCCQ score were significantly increased compared with baseline, and the increase was more obvious with the prolongation of treatment time(P<0.05). There were no significant changes in glomerular filtration rate(EGFR) and serum K+ between baseline and baseline. Conclusion Sacubitril/valsartan could improve cardiac function and control cardiac remodeling in heart failure with reduced ejection fraction patients. With the time persistence the effect of Sacubitril/valsartan is incredibly effective and has high safety.更多还原