老年急性冠状动脉综合征合并心力衰竭介入术后早期应用沙库巴曲缬沙坦的疗效  

Therapeutic effectiveness of sacubitril/valsartan in elderly ACS patients with HF after PCI

作　　者：刘赫男 涂建波 沈建 付振虹 王禹 Liu Henan;Tu Jianbo;Shen Jian;Fu Zhenhong;Wang Yu(Chinese PLA Medical School,Department of Cardiology,Chinese PLA General Hospital No.1 Medical Center,Beijing 100853,China)

机构地区：[1]解放军医学院解放军总医院第一医学中心心内科,北京100853 [2]61889部队门诊部

出　　处：《中华老年心脑血管病杂志》2022年第4期363-366,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81670218)。

摘　　要：目的研究老年急性冠状动脉综合征(ACS)合并射血分数减低的心力衰竭(HFrEF)患者PCI术后早期用沙库巴曲缬沙坦(V/S)的临床疗效。方法连续入选解放军总医院收治的ACS合并HFrEF行PCI患者134例,按诊断分为不稳定性心绞痛(UAP)组71例、ST段抬高型心肌梗死(STEMI)组31例和非ST段抬高型心肌梗死(NSTEMI)组32例,3组均常规治疗联合口服V/S,随访>6个月。比较3组治疗1及6个月心功能及心脏重构指标,记录主要不良心脏事件(MACE)及不良反应发生情况。结果与治疗前和治疗1个月比较,3组治疗6个月后LVEF、左心室短轴缩短率(LVFS)、左心室质量指数(LVMI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)有明显改善(P<0.05)。3组治疗6个月后LVEF、LVFS、LVEDVI、LVESVI比较,有统计学差异(P<0.05,P<0.01);NSTEMI组和STEMI组患者LVEF、LVFS、LVEDVI、LVESVI改善显著优于UAP组(P<0.05),NSTEMI组LVMI改善显著优于UAP组(P<0.05)。随访期间UAP组、STEMI组和NSTEMI组患者MACE及不良反应发生率比较,无统计学差异(11.27%vs 6.25%vs 6.45%,7.04%vs 6.25%vs 9.68%,P>0.05)。结论老年ACS合并HFrEF患者PCI术后早期应用V/S,可显著改善心功能并逆转心脏重构。Objective To study the clinical therapeutic effectiveness of sacubitril/valsartan(S/V) in elderly ACS patients with HFrEF after PCI.Methods One hundred and thirty-four ACS patients with HFrEF who underwent PCI in our hospital were divided into UAP group(n=71),STEMI group(n=31) and STEMI-free group(n=32).The patients in 3 groups who received routine treatment combined with oral S/V were followed up for >6 months.Their cardiac function and remodeling parameters were compared, the incidence of MACE and adverse reactions was recorded at months 1 and 6 after treatment.Results The LVEF,LVFS,LVMI,LVEDVI and LVESVI were significantly higher in 3 groups at month 6 after treatment than before treatment and at month 1 after treatment(P<0.05).No significant difference was detected in incidence of MACE and adverse reactions in 3 groups during the follow-up period(11.27% vs 6.25% vs 6.45%,7.04% vs 6.25% vs 9.68%,P>0.05).Conclusion S/V can significantly improve the cardiac function and reverse the cardiac remodeling in elderly ACS patients with HFrEF after PCI.

关 键 词：急性冠状动脉综合症 心力衰竭 经皮冠状动脉介入治疗 沙库巴曲缬沙坦 

分 类 号：R969[医药卫生—药理学]