沙库巴曲缬沙坦治疗老年射血...患者的临床效果及安全性分析_张东青.pdf

黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2药物应用心力衰竭为各类心血管病症的终末期表现，患病率与致死率均较高1-2。伴随病情的持续发展，患者心功能将沙库巴曲缬沙坦治疗老年射血分数降低心衰患者的临床效果及安全性分析张东青，李园园河南科技大学第一附属医院心血管内科，河南洛阳471000摘要目的：探讨沙库巴曲缬沙坦治疗老年射血分数降低心衰患者的临床效果。方法：选取2019年8月2020年8月河南科技大学第一附属医院收治的86例老年射血分数降低心衰患者作为研究对象，按随机数表法分为对照组与观察组，每组各43例。对照组施行常规西医，观察组在对照组的基础上加以沙库巴曲缬沙坦，持续用药30 d，对比两组患者临床疗效、心功能指标、肾功能指标、不良反应发生情况。结果：观察组治疗总有效率为90.70%，明显高于对照组的72.09%，差异有统计学意义（2=4.914，P0.05）。治疗前，两组患者LVEF、LVEDD、LVPW比较，差异无统计学意义（t=0.195、0.096、0.050，P0.05），治疗30 d后，观察组LVEF、LVEDD、LVPW分别为（49.572.68）%、（53.432.14）mm、（7.631.25）mm，均优于对照组的（45.432.24）%、（57.252.72）mm、（9.861.58）mm，差异有统计学意义（t=7.772、7.238、7.258，P0.05）。治疗前，两组患者BUN、Cr比较，差异无统计学意义（t=0.054、0.018，P0.05），治疗30 d后，观察组 BUN、Cr 分别为（6.441.32）mmol/L、（89.279.14）mol/L，均低于对照组的（9.571.87）mmol/L、（134.419.57）mol/L，差异有统计学意义（t=8.967、22.368，P0.05）。观察组不良反应发生率为6.98%，明显低于对照组的25.58%，差异有统计学意义（2=5.460，P0.05）。结论：沙库巴曲缬沙坦治疗老年射血分数降低心衰患者，能够改善患者心肾功能，有利于患者症状缓解，加快其康复进程，且安全性良好。关键词老年射血分数降低心衰；沙库巴曲缬沙坦；心功能；肾功能doi10.3969/j.issn.1004-5775.2023.02.012学科分类代码320.2435中图分类号R657.4文献标识码BClinical Effects and Safety Analysis of Sakubatril Valsartan in the Treatment of Elderly Patients with Heart Failurewith Reduced Ejection Fraction/ZHANG Dong-qing,LI Yuan-yuan/Department of Cardiovascular Medicine,The FirstAffiliated Hospital of Henan University of Science and Technology,Luoyang,Henan,471000,ChinaAbstract Objective:To investigate the value of sakubatril valsartan in the treatment of elderly patients with heart failure withreduced ejection fraction.Methods:86 elderly patients with heart failure with reduced ejection fraction admitted to the hospitalfrom August 2019 to August 2020 were selected as study subjects and divided into control and observation groups by random number table method,with 43 cases in each group.In the control group,conventional Western medicine was administered,and in theobservation group,sakubatril valsartan was added to the control group.The clinical efficacy,cardiac function indexes,renal function indexes and the occurrence of adverse reactions were compared between the two groups of patients after 30 d of continuousmedication.Results:The total effective rate of treatment in the observation group was 90.70%,which was significantly higher than72.09%in the control group,and the difference was statistically significant(2=4.914,P0.05).Before treatment,there was no statistically significant difference in LVEF,LVEDD,and LVPW between the two groups(t=0.195,0.096,0.050,P0.05).After 30 dof treatment,LVEF,LVEDD,and LVPW in the observation group were(49.572.68)%,(53.432.14)mm,and(7.631.25)mm,which were better than(45.432.24)%,(57.252.72)mm,and(9.861.58)mm in the control group,and the differences were statistically significant(t=7.772,7.238,7.258,P0.05).Before treatment,there was no statistically significant difference in BUN andCr between the two groups(t=0.054,0.018,P0.05).After 30 d of treatment,BUN and Cr in the observation group were(6.441.32)mmol/L and(89.279.14)mol/L,respectively,which were lower than(9.571.87)mmol/L and(134.419.57)mol/L in thecontrol group,with statistically significant differences(t=8.967,22.368,P0.05).The incidence of adverse reactions was 6.98%inthe observation group,which was significantly lower than that of 25.58%in the control group,and the difference was statisticallysignificant(2=5.460,P0.05).Conclusion:The treatment of elderly patients with heart failure with reduced ejection fraction withsakubatril valsartan improves cardiac and renal function,facilitates the relief of patients symptoms,accelerates their recovery process,and has a good safety profile.Keywords Geriatric reduced ejection fraction heart failure;Sakubatril valsartan;Cardiac function;Renal function169黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2会遭受到程度不同的损害，左心室厚度也呈现进行性加重，致使射血分数降低心衰疾病形成，严重威胁患者的生命安全3-4。既往临床多采用强心、扩血管等药物，缓解其症状，以控制病情进程，但老年人对药物耐受性较低，易出现较多不良反应，加剧临床治疗难度。沙库巴曲缬沙坦作为盐复合物晶体，通过抑制脑啡肽酶与AT1受体，以达到抗心力衰竭功效5-6。基于此，本研究选取2019年8月2020年8月河南科技大学第一附属医院收治的86例老年射血分数降低心衰患者作为研究对象，分析沙库巴曲缬沙坦应用于老年射血分数降低心衰患者中的临床效果及安全性，现将结果报告如下。1资料与方法1.1一般资料选取2019年8月2020年8月河南科技大学第一附属医院收治的86例老年射血分数降低心衰患者作为研究对象，按随机数表法分为对照组与观察组，每组各43例。对照组：女 20 例，男 23 例；年龄 6180 岁，平均年龄（69.862.43）岁；病程 38 年，平均病程（5.791.14）年；心功能分级为级18例，级13例，级12例；体重指数（BMI）18.627.3 kg/m2，平均BMI（24.380.57）kg/m2。观察组：女 19 例，男 24 例；年龄 6279 岁，平均年龄（69.252.36）年；病程39年，平均病程（5.831.16）年；心功能分级为级 19 例，级 11 例，级 13 例；BMI18.527.4 kg/m2，平均BMI（24.360.61）kg/m2。两组患者一般资料具有可比性（P0.05）。本研究经医院医学伦理委员会批准通过。1.2入选标准纳入标准：（1）符合心血管病诊疗手册7有关标准。（2）左心室射血分数（LVEF）40%。（3）伴有呼吸困难、心动过速等特征。（4）患病时间6个月。（5）知晓本研究并参与。（6）肌酐（Cr）为 133451 mol/L。（7）所有患者的病例有关资料齐全。（8）患者具有较为优良的依从性。排除标准：（1）安装辅助循环装置。（2）患有心肌炎、恶性心律失常。（3）消化道出血、严重脱水。（4）肝肾功能不足。（5）合并严重的脑器质性疾病。（6）存在凝血功能异常。（7）意识障碍，无法进行正常沟通。1.3方法对照组施行常规西医，给予限盐、休息，运用利尿剂、血管舒张剂、洋地黄等药物进行常规抗心衰处理，密切关注患者电解质水平。观察组在对照组基础上加以沙库巴曲缬沙坦片（Novartis Pharma Schweiz AG，国药准字：J20190002）治疗，起始的剂量为50 mg/次，2次/d，然后依据患者病情改善状况调整药量，最大药量为400 mg/d。两组患者均连续治疗30 d。1.4观察指标（1）比较两组患者临床疗效：症状消失、心功能提升2级及以上为显效；症状显著缓解、心功能提升1级及以上为有效；各项临床表现、心功能无变化为无效。总有效率=显效率+有效率。（2）比较两组患者心功能指标：于