沙库巴曲/缬沙坦在维持性血液透析高血压65例中的应用  

Application of sacubitril/valsartan in maintenance hemodialysis hypertension in 65 cases

作　　者：骆蓓蓓 李胜开 LUO Beibei;LI Shengkai(Nephrology Department,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院肾内科,江苏徐州221000

出　　处：《安徽医药》2023年第6期1263-1268,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨沙库巴曲/缬沙坦(SV)治疗维持性血液透析(MHD)高血压病人的疗效及安全性。方法 回顾性分析2020年1月至2021年9月徐州医科大学附属医院血液净化中心MHD合并高血压病人的病历资料,其中服用SV降压65例(观察组),服用缬沙坦降压65例(对照组)。对比治疗前、治疗1周、4周、12周透析前后血压情况,同时分析治疗前及治疗12周心脏彩超参数、血常规、血生化变化情况以及不良反应事件发生情况。结果 观察组治疗1周后透析后收缩压较治疗前下降,治疗4周后透析前和透析后收缩压分别较治疗前及治疗1周下降,治疗12周透析前收缩压、透析前舒张压、透析后收缩压、透析后舒张压分别较治疗前下降,治疗12周观察组病人透析前舒张压、透析后收缩压及透析后舒张压均低于对照组[(78.20±9.23)mmHg比(81.66±7.83)mmHg、(144.43±9.15)mmHg比(154.72±9.62)mmHg、(77.45±8.76)mmHg比(81.98±7.85)mmHg](P<0.05);观察组中合并射血分数降低的心力衰竭(HFrEF)和射血分数中间值的心力衰竭(HFmrEF)病人治疗12周左心射血分数(LVEF)均较治疗前提高,N末端前B型利钠肽、左室舒张末期内径均较治疗前下降,其中LVEF与对照组相比差异有统计学意义(P<0.05);观察组治疗前超敏C反应蛋白高于对照组,治疗12周低于对照组(P<0.05);两组病人治疗前及治疗12周血红蛋白、白蛋白、血清钾、血肌酐组间比较均差异无统计学意义(P>0.05)。结论 沙库巴曲缬沙坦能有效降低MHD病人的血压,提高MHD合并HFrEF和HFmrEF病人的LVEF,安全性较好。Objective To investigate the efficacy and safety of sacubitril/valsartan(SV)in the treatment of maintenance hemodialysis(MHD)patients with hypertension.Methods The clinical records of patients with MHD complicated with hypertension in the blood purification center of the Affiliated Hospital of Xuzhou Medical University from January 2020 to November 2021 were retrospectively analyzed,including 65 cases with SV for blood pressure lowering(observation group)and 65 cases with valsartan for blood pressure lowering(control group).The blood pressure before and after dialysis before treatment and at 1 week,4 weeks and 12 weeks of treatment were compared,and the cardiac ultrasound parameters,routine blood tests,blood biochemical changes and the occurrence of adverse reactions before and after 12 weeks of treatment were also analyzed.Results The systolic blood pressure(SBP)after hemodialysis in the observation group decreased after 1 week of treatment compared with that before treatment.After 4 weeks of treatment,the SBP before hemodialysis and after hemodialysis decreased compared with those before treatment and 1 week of treatment,respectively.After 12 weeks of treatment,SBP before hemodialysis,diastolic blood pressure(DBP)before hemodialysis,SBP after hemodialysis,and DBP after hemodialysis decreased compared with those before treatment.DBP before hemodialysis and SBP and DBP after hemodialysis were lower in the observation group than in the control group at 12 weeks of treatment[(78.20±9.23)mmHg vs.(81.66±7.83)mmHg,(144.43±9.15)mmHg vs.(154.72±9.62)mmHg,(77.45±8.76)mmHg vs.(81.98±7.85)mmHg](P<0.05).After 12 weeks of treatment,the left heart ejection fraction(LVEF)of MHD patients complicated with heart failure with reduced ejection fraction(HFrEF)and heart failure with mid-range ejection fraction(HFmrEF)in the observation group was higher than before treatment,and the N-terminal pro-Btype natriuretic peptide and left ventricular end-diastolic diameter decreased compared with those before treatment,with a statistic

关 键 词：沙库巴曲/缬沙坦 维持性血液透析 高血压 心力衰竭 C反应蛋白质 

分 类 号：R692.5[医药卫生—泌尿科学] R544.1[医药卫生—外科学]