沙库巴曲缬沙坦钠联合托伐普坦治疗急性心肌梗死后心力衰竭的疗效及对内皮功能、炎症因子的影响  

Efficacy of sacubitril valsartan sodium combined with tolvaptan in treating heart failure after acute myocardial infarction and its effect on endothelial function and inflammatory factors

作　　者：赵红娟[1] 郑云龙[1] 陈冠鹏[1] 梁普博[1] 苏丹霞[1] 罗家典 Zhao Hongjuan;Zheng Yunlong;Chen Guanpeng;Liang Pubo;Su Danxia;Luo Jiadian(Department of cardiovascular medicine,Guangdong agricultural reclamation central hospital,Zhanjiang,Guangdong,524002,China)

机构地区：[1]广东省农垦中心医院心血管内科,广东湛江524002

出　　处：《齐齐哈尔医学院学报》2022年第20期1915-1920,共6页Journal of Qiqihar Medical University

摘　　要：目的观察并分析沙库巴曲缬沙坦钠联合托伐普坦治疗急性心肌梗死后心力衰竭的疗效及对内皮功能、炎症因子的影响。方法选择2020年2月-2021年2月本院收治的90例急性心肌梗死后并发心力衰竭的患者作为研究对象分为对照A组、对照B组和观察组三组,每组各30例。三组患者均给予相同的利尿、强心、扩血管等常规药物治疗,对照A组在基础治疗上给予沙库巴曲缬沙坦钠治疗;对照B组在基础治疗上给予托伐普坦治疗;观察组在基础治疗的基础上给予沙库巴曲缬沙坦钠联合托伐普坦治疗。三组患者按诊疗计划治疗观察2周,出院带药,遵医嘱持续服药2个月,在治疗后1、3、6、12个月至门诊随访,随访时间为1年,以患者出现心源性死亡、再发心衰或随访1年作为随访终点。比较三组患者临床疗效,治疗前后左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)、N端脑钠肽前体(NT-proBNP)、内皮素(ET)、降钙素基因相关肽(CGRP)、血清一氧化氮(NO)、肿瘤坏死因子(TNF)-α、白介素(IL)-6、高敏C反应蛋白(hs-CRP)以及用药不良反应。结果观察组治疗总有效率为93.33%,明显高于对照组A组(73.33%)及对照B组(70.00%)(P<0.05);三组治疗后较治疗前LVEF、CO、CGRF、NO、血钠水平水平升高(P<0.05),LVESD、LVEDD、NT-proBNP、ET、TNF-α、IL-6、hs-CRP水平降低(P<0.05),观察组较对照A、B组LVEF、CO、CGRF、NO、血钠水平显著升高(P<0.05),LVEDD、NT-proBNP、ET、TNF-α、IL-6、hs-CRP显著降低(P<0.05);对比用药安全性,三组患者药品不良反应发生率无明显差异(P>0.05)。结论沙库巴曲缬沙坦钠联合托伐普坦对于急性心肌梗死后心力衰竭的治疗疗效明确,能够有效改善患者心功能和血管内皮功能,降低机体血清炎症因子水平。Objective To observe and analyze the effect of sacubitril valsartan sodium and tolvaptan on heart failure after acute myocardial infarction and its effect on endothelial function and inflammatory factors.Methods A total of 90 patients suffered from heart failure after acute myocardial infarction those who were admitted to our hospital from February 2020 to February 2021 were selected as the research subjects,andthey were randomly divided into control group A,control group B and observation group,with 30 cases in each group.The patients in the three groups were given the same routine drug treatments such as diuresis,cardiac strengthening,and vascular expansion.Based on this those in the control group A were given the sacubitril valsartan sodium in addition.Patients in the control group B were treated with tolvaptan on the basis of basic treatment.On the basis of basic treatment,patients in the observation group were given the combination treatment of sacubitril valsartan sodium and tolvaptan.The patients in the three groups were treated and observed for 2 weeks according to the diagnosis and treatment plan.They were discharged with medicine,and kept administrating medicine for 2 months according to the doctor's advice.They were followed up at the outpatient department within 1,3,6,and 12 months after treatment.The follow-up time was 1 year.The patients'cardiogenic death,recurrent heart failure,or follow-up for 1 year served as the follow-up endpoint.The clinical effects of the three groups were compared.Left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVEDD),N-terminal brain natriuretic peptide precursor(NT-proBNP),endothelin(ET),calcitonin gene-related peptide(CGRP),serum nitric oxide(NO),tumor necrosis factor(TNF)-α,interleukin(IL)-6,high-sensitivity C-reactive protein(hs-CRP)at before and after treatmentand adverse reactions were compared.Results The total effective rate was 93.33%in the observation group,and it was significantly

关 键 词：急性心肌梗死 心力衰竭 沙库巴曲缬沙坦钠 托伐普坦 疗效 血管内皮功能 炎症因子 

分 类 号：R541[医药卫生—心血管疾病]