作者：尹成龙，丁佳佳

单位：

211500江苏省南京市，东南大学附属中大医院江北院区急诊医学科

Units：

Department of Emergency Medicine, Zhongda Hospital Southeast University (Jiangbei) , Nanjing 211500, China

关键词：

心力衰竭；重组人脑利钠肽；沙库巴曲缬沙坦；心功能；预后

Keywords：

Heart failure; Recombinant human brain natriuretic peptide; Sacubitril valsartan; Cardiac function;Prognosis

CLC：

R 541.62

DOI：

10.12114/j.issn.1008-5971.2023.00.176

Funds：

江苏省卫生健康委科研项目（K2019024)

摘要：

目的　探讨沙库巴曲缬沙坦与重组人脑利钠肽（rhBNP）序贯治疗急性心力衰竭（AHF）患者的效果及预后。方法　选取2020年1月至2022年1月东南大学附属中大医院江北院区收治的AHF患者104例，采用信封法将其分为观察组与对照组，每组52例。所有患者入院后接受常规干预，在此基础上对照组患者于发病24 h内接受rhBNP治疗，观察组患者在对照组基础上接受沙库巴曲缬沙坦治疗；两组均连续治疗1个月。比较两组临床疗效、临床症状改善时间、住院时间、治疗后6 min步行距离和治疗前后血压、心功能指标〔心率、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）〕、实验室检查指标〔去甲肾上腺素（NE）、内皮素1（ET-1）、N末端脑钠肽前体（NT-proBNP）〕及出院后6个月内因心力衰竭再入院率。采用多因素Logistic回归分析探讨AHF患者出院后6个月内因心力衰竭再入院的影响因素。结果　观察组临床疗效优于对照组（P＜0.05）。观察组临床症状改善时间、住院时间短于对照组，治疗后6 min步行距离长于对照组（P＜0.05）。两组治疗后收缩压、舒张压、心率分别低于本组治疗前，LVEF分别高于本组治疗前，LVEDD分别小于本组治疗前，且观察组治疗后收缩压、心率低于对照组（P＜0.05）。两组治疗后NE、ET-1、NT-proBNP分别低于本组治疗前，且观察组治疗后NE、ET-1、NT-proBNP低于对照组（P＜0.05）。观察组出院后6个月内因心力衰竭再入院率低于对照组（P＜0.05）。多因素Logistic回归分析结果显示，年龄、NYHA分级、合并高脂血症及治疗方法是AHF患者出院后6个月内因心力衰竭再入院的独立影响因素（P＜0.05）。结论　沙库巴曲缬沙坦与rhBNP序贯治疗AHF患者的效果确切，可有效缩短患者临床症状改善时间及住院时间，改善循环功能，减轻心肌损伤，降低出院后6个月内因心力衰竭再入院率。

Abstract：

Objective To investigate the effect and prognosis of sequential therapy of shakubactrivalsartan andrecombinant human brain natriuretic peptide (rhBNP) in patients with acute heart failure (AHF) . Methods A total of 104patients with AHF admitted to Zhongda Hospital Southeast University (Jiangbei) from January 2020 to January 2022 weredivided into observation group and control group by envelope method, with 52 cases in each group. All patients received routineintervention after admission, and the control group received rhBNP treatment within 24 h after onset. Observation group wastreated with shakubactrivalsartan on the basis of control group. Both groups received continuous medication for 1 month. Theclinical efficacy, improvement time of clinical symptoms, length of hospital stay, 6 min walking distance after treatment, and bloodpressure, cardiac function indexes [heart rate, left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter(LVEDD) ] , laboratory indexes [norepinephrine (NE) , endothelin-1 (ET-1) , N-terminal pro-brain natriuretic peptide (NTproBNP) ] before and after treatment and the incidence of readmission due to heart failure within 6 months after discharge werecompared between the two groups. Multivariate Logistic regression analysis was used to investigate the influencing factors ofreadmission due to heart failure within 6 months after discharge in patients with AHF. Results The clinical effect of observationgroup was better than that of control group (P < 0.05) . The improvement time of clinical symptoms and length of hospital stay inthe observation group were shorter than those in the control group, and the 6 min walking distance after treatment was longer thanthat in the control group (P < 0.05) . Systolic blood pressure, diastolic blood pressure, heart rate after treatment in the two groups were lower than those before treatment respectively, LVEF was higher than that before treatment respectively, LVEDD was lessthan that before treatment respectively, and systolic blood pressure and heart rate after treatment in the observation group werelower than those in the control group (P < 0.05) . NE, ET-1 and NT-proBNP after treatment in the two groups were lower thanthose before treatment respectively, and NE, ET-1 and NT-proBNP after treatment in the observation group were lower thanthose in the control group (P < 0.05) . The readmission rate due to heart failure within 6 months after discharge in the observationgroup was lower than that in the control group (P < 0.05) . Multivariate Logistic regression analysis showed that age, NYHA grade,hyperlipidemia and treatment method were independent influencing factors for readmission due to heart failure within 6 monthsafter discharge in AHF patients (P < 0.05) . Conclusion The sequential therapy of shakubactrivalsartan and rhBNP has adefinite effect on patients with AHF, which can effectively shorten the time of clinical symptom improvement and length of hospitalstay of patients, improve circulatory function, reduce myocardial injury and readmission rate due to heart failure within 6 monthsafter discharge.

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