作者：孙雨，王昊，刘宝山，张爱元

单位：

1.261000山东省潍坊市，潍坊医学院内科学教研室　2.261000山东省潍坊市人民医院心血管内科

Units：

1.Department of Internal Medicine, Weifang Medical University, Weifang 261000, China2.Department of Cardiology, Weifang People's Hospital, Weifang 261000, China

关键词：

心力衰竭；心房颤动；沙库巴曲缬沙坦

Keywords：

Heart failure; Atrial fibrillation; Sarkubatrivalsartan

CLC：

R 541.62 R 541.75

DOI：

10.12114/j.issn.1008-5971.2023.00.192

Funds：

山东省自然科学基金青年项目（ZR2020QH005）；潍坊市科技发展计划项目（2022YX082）

摘要：

目的　探讨沙库巴曲缬沙坦治疗慢性心力衰竭（CHF）伴持续性心房颤动（PAF）的效果。方法　选取2020年7月至2022年7月潍坊市人民医院心血管内科收治的CHF伴PAF患者80例，根据单双号抽签法将其分为观察组和对照组，每组40例。所有患者接受基础治疗，此外，观察组患者加用沙库巴曲缬沙坦钠片，对照组患者加用缬沙坦胶囊，两组患者均连续治疗6个月。比较两组治疗前后心脏超声相关指标〔左心室前后径、左心房前后径、左心室射血分数（LVEF）〕、心功能指标〔N末端脑钠肽前体（NT-proBNP）、6 min步行距离〕、明尼苏达心力衰竭生活质量问卷（MLHFQ）评分、血肌酐、血钾、估算肾小球滤过率（eGFR）和随访结果（因心力衰竭再住院情况、缺血性脑卒中发生情况）。结果　观察组治疗后左心室前后径、左心房前后径小于本组治疗前，LVEF高于本组治疗前（P＜0.05）。两组治疗后NT-proBNP分别低于本组治疗前，观察组治疗后6 min步行距离长于本组治疗前，且观察组治疗后NT-proBNP低于对照组，6 min步行距离长于对照组（P＜0.05）。观察组治疗后MLHFQ评分低于本组治疗前及对照组（P＜0.05）。两组治疗前后血肌酐、血钾、eGFR比较，差异无统计学意义（P＞0.05）。观察组因心力衰竭再住院率低于对照组（P＜0.05）。结论　沙库巴曲缬沙坦能延缓、逆转CHF伴PAF患者心肌重构，改善心功能，提高患者的生活质量，减少因心力衰竭再住院情况，且安全性良好。

Abstract：

　Objective To investigate the effect of sarkubatrivalsartan in the treatment of chronic heart failure (CHF)with persistent atrial fibrillation (PAF) . Methods A total of 80 patients with CHF and PAF admitted to Department of Cardiologyof Weifang People's Hospital from July 2020 to July 2022 were selected and divided into observation group and control groupaccording to odd-even drawing method, with 40 cases in each group. All patients received basic treatment, in addition, observationgroup was treated with sacubattril valsartan sodium tablets, and valsartan capsules were added to control group. Both groups weretreated for 6 months. Cardiac ultrasound related indicators [left ventricular anteroposterior diameter, left atrial anteroposteriordiameter, left ventricular ejection fraction (LVEF) ] , cardiac function indicators [N-terminal brain pro-natriuretic peptide(NT-proBNP) , 6-minute walking distance] , the Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores, serumcreatinine, serum potassium, estimated glomerular filtration rate (eGFR) before and after treatment, and follow up results(readmission due to heart failure and ischemic stroke incidence were compared between the two groups. Results After treatment,the left ventricular anteroposterior diameter and left atrial anteroposterior diameter in the observation group were smaller thanthose before treatment, and LVEF was higher than that before treatment (P < 0.05) . After treatment, NT-proBNP in both groupswas lower than that before treatment respectively, 6-minute walking distance in the observation group was longer than that beforetreatment, and NT-proBNP in the observation group was lower than that in the control group, 6-minute walking distance waslonger than that in the control group (P < 0.05) . After treatment, MLHFQ score in the observation group was lower than thatbefore treatment, and MLHFQ score in the observation group was lower than that in the control group (P < 0.05) . There was nosignifficant difference in serum creatinine, serum potassium and eGFR between the two groups before and after treatment (P > 0.05) . The readmission rate due to heart failure in the observation group was lower than that in the control group (P < 0.05) .Conclusion Sackubactril valsartan can delay and reverse myocardial remodeling in patients with CHF and PAF, improve heartfunction and patients' quality of life, reduce readmission due to heart failure, and with good safety.

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