沙库巴曲缬沙坦联合左束支起搏治疗慢性心力衰竭的疗效  

Efficacy of sacubitril valsartan combined with left bundle branch pacing in the treatment of chronic heart failure

作　　者：陈会校[1] 李娟[1] 韩继如 张巍[1] 刘存祥 李俊峡 房健健 CHEN Hui-xiao;LI Juan;HAN Ji-ru;ZHANG Wei;LIU Cun-xiang;LI Jun-xia;FANG Jian-jian(Department of Cardiology,Handan First Hospital,Handan 056002,Hebei,China;Department of Critical Medicine,Handan First Hospital,Handan 056002,Hebei,China;Department of Surgery,Weixian Hospital of Traditional Chinese Medicine,Handan 056800,Hebei,China;Department of Cardiology,General Army Hospital,Beijing 100700,China)

机构地区：[1]邯郸市第一医院心内四科,河北邯郸056002 [2]邯郸市魏县中医院外三科,河北邯郸056800 [3]陆军总医院心内科,北京3100700 [4]邯郸市第一医院重症医学科,河北邯郸056002

出　　处：《中国心脏起搏与心电生理杂志》2021年第4期315-319,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：河北省卫生健康委科研基金项目(项目编号:20200428)。

摘　　要：目的探讨沙库巴曲缬沙坦联合左束支起搏在心力衰竭中的应用价值.方法选取2016年6月至2018年6月邯郸市第一医院收治的合并左束支阻滞具有心脏再同步化治疗植入指证的慢性心力衰竭患者30例作为研究对象,随机数字表法分为试验组(15例)和对照组(15例).两组均采取左束支起搏,术后在常规治疗心力衰竭基础上,分别使用沙库巴曲缬沙坦和依那普利,治疗6个月.测定两组术中,术后1、3及6个月电极参数,测量术前和术后6个月的QRS波时限、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、N末端前体脑钠肽(NT-ProB-NP)、可溶性肿瘤生长抑制因子2(sST2).结果两组的年龄、性别、吸烟史、血压、血糖等基础资料无差异(P均>0.05).两组患者治疗后QRS波时限明显小于治疗前[(108.4±10.0)msvs(158.3±9.5)ms,(106.5±10.3)ms vs(160.2±10.1)ms,P均<0.05],术中测试导线单、双极参数均良好,术后1个月单、双极阻抗均较术中明显下降(P<0.001),起搏阈值及感知参数无变化.术后3至6个月随访单、双极起搏阈值、感知以及阻抗参数均稳定.经治疗后两组较治疗前LVEDD均明显下降[(47.6±4.2)mmvs(58.7±6.1)mm,(50.1±3.5)mmvs(57.8±5.5)mm,P均<0.05],LVEF升高[0.50±0.06vs0.36±0.05,0.44±0.05vs0.36±0.05,P均<0.05)],试验组LVEF升高及LVEDD缩小明显好于对照组(P<0.05).两组治疗后NT-ProBNP、sST2较治疗前下降[(1470±312)μg/Lvs(7050±2015)μg/L,(2641±340)μg/Lvs(6500±1648)μg/L;(0.32±0.33)μg/Lvs(0.67±0.24)μg/L,(0.41±0.24)μg/Lvs(0.66±0.23)μg/L,P均<0.05],试验组优于对照组(P<0.05).结论沙库巴曲缬沙坦联合左束支起搏治疗慢性心力衰竭优于依那普利联合左束支起搏治疗.Objective To investigate the value of sacubitril valsartan combined with left bundle branch pacing in the treatment of chronic heart failure.Methods From June 2016 to June 2018,30 patients with chronic heart failure who were admitted to the First Hospital of Handan City with left bundle branch block and permanent pacemaker implantation were selected as the research objects.The patients were randomly divided into the experimental group(15 cases)and the control group(15 cases),and meanwhile on the basis of routine treatment of heart failure,the patients were treated with sacubitril,valsartan and enalapril respectively for a duration of six month.The two groups were compared for QRS duration,parameters of pacemaker,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),N-terminal pro B-type natriuretic peptides(NT-ProBNP)and soluble suppression of tumorigenicity 2(sST2)were recorded.Results Basic characteristics,including age,gender,clinical history of hypertension and diabetes,showed no significant difference between two groups(P<0.05).The QRS duration of 30 patients after treatment was significantly shorter than that before treatment[(108.4±10.0)ms vs(158.3±9.5)ms,(106.5±10.3)ms vs(160.2±10.1)ms,P<0.05].The parameters of both unipolar and bipolar leads were satisfactory during theimplantation and remained stable in middle-and long-term follow-up.the LVEDD of both groups decreased significantly[(47.6±4.2)mm vs(58.7±6.1)mm,(50.1±3.5)mm vs(57.8±5.5)mm,P<0.05]and LVEF increased after treatment[0.50±0.06 vs 0.36±0.05,0.44±0.05 vs 0.36±0.05,P<0.05].The increase of LVEF and the decrease of LVEDD in the experimental group were significantly better than those in the control group(P<0.05),After treatment,NT-ProBNP and sST2 decreased in both groups[(1470±312)μg/L vs(7050±2015)μg/L,(2641±340)μg/L vs(6500±1648)μg/L;(0.32±0.33)μg/L vs(0.67±0.24)μg/L,(0.41±0.24)μg/L vs(0.66±0.23)μg/L,P<0.05],and those in the experimental group was better than those in the control group

关 键 词：心血管病学 左束支起搏 心力衰竭 沙库巴曲缬沙坦 生理性起搏 心脏再同步化治疗 

分 类 号：R318.11[医药卫生—生物医学工程] R541.61[医药卫生—基础医学]