【摘要】 目的观察重组人脑利钠肽、沙库巴曲缬沙坦、托伐普坦序贯治疗高龄射血分数降低的心力衰竭(HFrEF)病人的疗效。方法选择我科80～90岁HFrEF病人40例,随机分为常规治疗组和序贯治疗组,每组20例。常规治疗组予以常规抗心衰药物治疗;序贯治疗组在停用血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ受体阻滞剂(ARB)基础上序贯使用重组人脑利钠肽、沙库巴曲缬沙坦、托伐普坦。治疗前后分别采用明尼苏达心衰生活质量问卷表(MLHFQ)、6 min步行试验(6MWT)评估病人心功能情况,采用心脏彩色多普勒超声检测病人LVEF、心排血量(CO)、每搏输出量(SV),同时检测病人血浆BNP、肾功能及血清电解质水平。结果治疗10 d后,序贯治疗组总有效率显著高于常规治疗组(P<0.05); 2组MLHFQ评分、6 min步行距离、LVEF、CO、SV、血浆BNP水平均较治疗前改善,且序贯治疗组上述指标较常规治疗组改善更明显(均P<0.05);常规治疗组血清K~+、Na~+水平均较治疗前下降(P<0.05),但序贯治疗组血清电解质水平较治疗前无明显变化(P>0.05)。2组病人肾功能指标治疗前后无明显变化(P<0.05)。结论重组人脑利钠肽、沙库巴曲缬沙坦、托伐普坦序贯治疗可以优势互补,有效改善高龄HFrEF病人的心功能状况。更多还原

【Abstract】 Objective To investigate the curative effect of sequential treatment of recombinant human brain natriuretic peptide,sacubitril/valsartan and tolvaptan on the elderly patients with heart failure with reduced ejection fraction( HFr EF). Methods A total of 40 patients with HFr EF aged 80 to 90 years old were randomly divided into conventional treatment group and sequential treatment group,with 20 cases in each group. The patients in conventional treatment group were treated with conventional anti-heart failure drugs. The patients in sequential treatment group were sequentially treated with recombinant human brain natriuretic peptide,sacubitril/valsartan and tolvaptan on the basis of stopping angiotensin converting enzyme inhibitor( ACEI)/angiotensin Ⅱ receptor blocker( ARB). Minnesota Living with Heart Failure Questionnaire( MLHFQ) and 6-minute walking test( 6 MWT) were used to evaluate the cardiac function of the patients,and cardiac color Doppler ultrasound was used to detect the left ventricular ejection fraction( LVEF),cardiac output( CO) and stroke volume( SV) of the patients.Additionally,the levels of plasma brain natriuretic peptide( BNP),renal function and serum electrolytes were also detected. Results After 10 days of treatment,the total effective rate of sequential treatment group was significantly higher than that of conventional treatment group( P <0. 05); The MLHFQ score,6 MWT distance,and the levels of LVEF,CO,SV and plasma BNP in both groups were all improved( P<0. 05),especially in sequential treatment group( P < 0. 05); The serum levels of K+and Na+in conventional treatment group were significantly lower than those before treatment( all P<0. 05),whereas there were no significant differences in the serum electrolytes levels of sequential treatment group after treatment( all P > 0. 05). In addition,there was no significant change in renal function of both groups after treatment( all P > 0. 05). Conclusions The sequential treatment of recombinant human brain natriuretic peptide,sacubitril/valsartan and tolvaptan could improve the cardiac function of the elderly patients with HFr EF effectively.更多还原