沙库巴曲缬沙坦对慢性心力衰竭合并肾功能不全患者容量管理的优化作用  

Optimization of volume management with sacubitril/valsartan in patients of chronic heart failure complicated with renal insufficiency

作　　者：贾红丹[1] 毕希乐[1] 赵云凤 宋婷婷[1] 刘丽[1] Jia Hongdan;Bi Xile;Zhao Yunfeng;Song Tingting;Liu Li(Department of Cardiology,First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei Province,China)

机构地区：[1]秦皇岛市第一医院心血管内科,河北秦皇岛066000

出　　处：《中华老年多器官疾病杂志》2023年第5期339-344,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：秦皇岛市重点研发计划项目(201805A042);河北省重点研发计划项目(182777235)。

摘　　要：目的 观察慢性心力衰竭(简称心衰)合并肾功能不全患者应用沙库巴曲缬沙坦后容量状态变化及其对心脏结构和功能的影响。方法 连续纳入2020年12月至2022年3月秦皇岛市第一医院收治的慢性心衰合并肾功能不全患者84例,分为沙库巴曲缬沙坦组(n=48)和对照组(n=36)。沙库巴曲缬沙坦组给予沙库巴曲缬沙坦,对照组接受单一的缬沙坦治疗。测量2组患者服药6个月后24 h尿量、利尿剂用量,检测血浆B型脑钠肽(BNP)水平,随访纽约心脏病协会(NYHA)分级变化,并以超声心动图评估心脏结构及功能变化情况。结果 与对照组比较,服药后沙库巴曲缬沙坦组患者24 h尿量明显增多[(1 514.38±694.73)和(1 003.33±178.92)ml;P<0.01];NYHA分级明显改善(P=0.032)。与服药前比较,服药后沙库巴曲缬沙坦组患者服用利尿剂剂量[(19.38±7.55)和(23.75±7.89)mg]、BNP水平[811(250,1 481)和1 980(727,5 014)pg/ml]明显降低(均P<0.01);24 h尿量[(1 514.38±694.73)和(890.63±121.45)ml]明显增加(P<0.01)。与对照组比较,服药后沙库巴曲缬沙坦组患者左室射血分数(LVEF)[(36.87±6.16)%和(33.08±7.59)%]、二尖瓣环E峰与A峰比值(E/A)[1.30(1.25,1.82)和1.04(0.59,2.53)]、每搏输出量(SV)[(102.39±20.85)和(77.98±18.51)ml]、心输出量(CO)[(7.39±2.18)和(5.84±1.72)L/min]均明显升高(均P<0.05),左房内径(LA)[(42.97±6.01)和(48.17±5.17)mm]缩小(P<0.05);与服药前比较,服药后沙库巴曲缬沙坦组患者左室收缩末内径[50.5(50.0,56.1)和54.0(48.3,61.9)mm]、左室舒张末内径[(64.9±10.3)和(69.0±12.1)mm]、LA[(42.97±6.01)和(47.61±8.06)mm]均明显缩小(均P<0.01);SV[(102.39±20.85)和(68.13±29.96)ml]、CO[(7.39±2.18)和(5.66±2.49)L/min]、E/A[1.30(1.25,1.82)和0.93(0.88,1.10)]、LVEF[(36.87±6.16)%和(27.26±6.24)%]均明显升高(均P<0.01)。结论 与单一使用缬沙坦比较,沙库巴曲缬沙坦可明显改善合并肾功能不全的慢性心衰患者的容量超负荷,优化容量管理措施Objective To observe the volume changes incurred by sacubitril/valsartan and its effects on cardiac structure and functions in patients with chronic heart failure(CHF)complicated with renal insufficiency.Methods A total of 84 CHF patients complicated with renal insufficiency were consecutively enrolled,who were admitted to the First Hospital of Qinghuangdao from December 2020 to March 2022.They were divided into sacubitril/valsartan group(n=48)and control group(n=36).The sacubitril/valsartan group received sacubitril/valsartan and the control group valsartan alone.On the follow-up visit after 6 months of medication,24-hour urine volume,diuretic dose,and brain natriuretic peptide(BNP)level were measured,New York Heart Association(NYHA)classification was performed,and cardiac structure and functions were evaluated by echocardiography in the two groups.Results Compared with the control group,24-hour urine volume in sacubitril/valsartan group increased significantly[(1514.38±694.73)vs(1003.33±178.92)ml;P<0.01],and NYHA classification was significantly improved(P=0.032)after therapy.Compared with the baseline,the dose of diuretic[(19.38±7.55)vs(23.75±7.89)mg]and the level of BNP[811(250,1481)vs 1980(727,5014)pg/ml]decreased significantly(P<0.01),and the urine volume in 24 h[(1514.38±694.73)vs(890.63±121.45)ml]increased significantly(P<0.01)at 6 months in the sacubitril/valsartan group.Compared with the control group,stroke output(SV)[(102.39±20.85)vs(77.98±18.51)ml],cardiac output(CO)[(7.39±2.18)vs(5.84±1.72)L/min],left ventricular ejection fraction(LVEF)[(36.87±6.16)%vs(33.08±7.59)%],mitral diastolic blood flow velocity E peak and A peak ratio(E/A)[1.30(1.25,1.82)vs 1.04(0.59,2.53)]increased significantly(P<0.05 for all),and left atrium(LA)[(42.97±6.01)vs(48.17±5.17)mm]decreased(P<0.05)in the sacubitril/valsartan group after therapy.The left ventricular end-diastolic diameter(LVEDD)[(64.9±10.3)vs(69.0±12.1)mm],left ventricular end-systolic diameter(LVESD)[50.5(50.0,56.1)vs 54.0(48.3,61.9)mm]and LA[(42

关 键 词：慢性心力衰竭 肾功能不全 沙库巴曲缬沙坦 容量管理 超声心动图 

分 类 号：R541.61[医药卫生—心血管疾病]