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沙库巴曲缬沙坦对射血分数中间值的心力衰竭及射血分数保留的心力衰竭患者肺动脉收缩压的影响研究 被引量:19

Impact of Sacubitril/Valsartan on Pulmonary Arterial Systolic Pressure in Patients with Heart Failure with Mid-range Ejection Fraction and Heart Failure with Preserved Ejection Fraction
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摘要 背景近年随着我国人口老龄化进程加剧,射血分数中间值的心力衰竭(HFmrEF)及射血分数保留的心力衰竭(HFpEF)发生率逐年升高。2018年《中国心力衰竭指南》推荐射血分数降低的心力衰竭(HFrEF)患者使用沙库巴曲缬沙坦替代血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)联合β-受体阻滞剂及醛固酮受体拮抗剂的治疗方案。但沙库巴曲缬沙坦治疗HFmrEF及HFpEF伴肺动脉收缩压(PASP)升高患者的疗效尚不清楚。目的探讨沙库巴曲缬沙坦对HFmrEF及HFpEF患者PASP的影响。方法选取2018年6月—2020年6月陕西省人民医院心内科收治的HFmrEF及HFpEF伴PASP升高患者83例,根据治疗方案分为对照组41例和观察组42例。在常规治疗基础上,对照组患者采用ACEI/ARB进行治疗,观察组患者采用沙库巴曲缬沙坦进行治疗,两组患者均连续治疗6个月。比较两组患者治疗前后超声心动图检查结果、6 min步行距离(6MWD)、心率、堪萨斯市心肌病变问卷总体汇总评分(KCCQ-OSS-15)、心功能及肾功能指标。随访6个月,比较两组患者不良事件及HF再住院发生情况。结果(1)观察组患者治疗后左心房内径(LAD)、右房室瓣反流速率峰值(TRV)、左心室舒张末期内径(LVEDD)、右心室舒张末期内径(RVEDD)小于对照组,左心室射血分数(LVEF)高于对照组,PASP低于对照组(P<0.05)。两组患者治疗后LAD、TRV、LVEDD、RVEDD分别小于本组治疗前,LVEF分别高于本组治疗前,PASP分别低于本组治疗前(P<0.05)。(2)观察组患者治疗后6MWD长于对照组,心率低于对照组,KCCQOSS-15高于对照组(P<0.05)。两组患者治疗后6MWD分别长于本组治疗前,心率分别低于本组治疗前,KCCQOSS-15分别高于本组治疗前(P<0.05)。(3)观察组患者治疗后脑钠肽(BNP)低于对照组(P<0.05)。两组患者治疗后BNP分别低于本组治疗前(P<0.05)。(4)随访6个月,两组患者心源性不良事件、症状性低血压� Background In recent years,with the aggravation of population aging in China,the incidence of heart failure with mid-rang ejection fraction(HFmrEF)and heart failure with preserved ejection fraction(HFpEF)has increased year by year.The 2018 Chinese Heart Failure Guidelines recommend to use sacubitril/valsartan replacing angiotensin converting enzyme inhibitor(ACEI)/angiotensinⅡreceptor blocker(ARB)combined withβ-blockers and aldosterone receptor antagonists in patients with heart failure with reduced ejection fraction(HFrEF).But the efficacy of sacubitril/valsartan in the treatment of HFmrEF and HFpEF with elevated pulmonary systolic blood pressure(PASP)is unclear.Objective To investigate the impact of sacubitril/valsartan on PASP in patients with HFmrEF and HFpEF.Methods A total of 83 cases of patients with HFmrEF and HFpEF complicated with high PASP were selected from June 2018 to June 2020 in Shaanxi Provincial People's Hospital,and they were divided into the control group(n=41)and the observation group(n=42)according to therapeutic regimen.On the basis of conventional treatment,patients in the control group were treated with ACEI/ARB,while patients in the observation group were treated with sacubitril/valsartan,both groups of partients were treated for 6 months.The echocardiography results,6-minute walking distance(6MWD),heart rate,the overall summary score of the 15-item Kansas City Cardiomyopathy Questionnaire(KCCQ-OSS-15),indexes of cardiac function and renal function were compared between the two groups before and after treatment.The incidence of adverse events and rehospitalization of HF were compared between the two groups after 6 months'follow-up.Results(1)Left atrial diameter(LAD),tricuspid regurgitation velocity(TRV),left ventricular end-diastolic diameter(LVEDD),right ventricular end-diastolic diameter(RVEDD)in the observation group were less than those of the control group,left ventricular ejection fraction(LVEF)was higher than that of the control group,PASP was lower than that of the control gro
作者 冯盼盼 郭伟 程功 贾硕 关蕾 张骥 FENG Panpan;GUO Wei;CHENG Gong;JIA Shuo;GUAN Lei;ZHANG Ji(Department of General Medicine,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Cardiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Xi'an Medical University,Xi'an 710021,China)
出处 《实用心脑肺血管病杂志》 2021年第6期93-98,共6页 Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词 心力衰竭 沙库巴曲缬沙坦 肺动脉收缩压 左心室射血分数 Heart failure Sacubitril/Valsartan Pulmonary arterial systolic pressure Left ventricular ejection fraction
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