血压动态监测沙库巴曲缬沙坦治疗慢性心力衰竭低血压及低血压发生的高危因素研究  

A study of hypotension and risk factors for the development of hypotension in chronic heart failure treated with blood pressure dynamic monitoring sakubatril valsartan

作　　者：贾红丹[1] 毕希乐[1] 赵云凤 宋婷婷[1] 刘丽[1] JIA Hong-dan;BI Xi-le;ZHAO Yun-feng(Department of Cardiovascular Medicine,Qinhuangdao First Hospital,Qinhuangdao Hebei 066000,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：《临床和实验医学杂志》2023年第12期1251-1254,共4页Journal of Clinical and Experimental Medicine

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

摘　　要：目的探究血压动态监测沙库巴曲缬沙坦治疗慢性心力衰竭低血压及低血压发生的高危因素。方法前瞻性选取2020年1月至2022年12月秦皇岛市第一医院收治的慢性心力衰竭合并低血压患者106例作为研究对象,按随机数字表法将患者分为治疗1组与治疗2组,各53例。另按2∶1比例选取同期本院收治的慢性心力衰竭不合并低血压患者53例作为对照组。治疗1组及治疗2组患者均接受心衰规范化基础治疗,治疗1组在治疗2组基础上给予沙库巴曲缬沙坦口服治疗,均连续治疗5个月。比较两组心脏结构、功能指标[左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)]、心率、动态血压指标[24 h平均脉搏率(24 h PR)、24 h平均收缩压变异性(24 h SBPV)、24 h平均舒张压变异性(24 h DBPV)],并通过二元Logistic回归分析慢性心力衰竭合并低血压影响因素。结果治疗后,两组的LVEDD、LVESD、心率与治疗前相比均降低,LVEF均升高,且治疗1组治疗后LVEDD、LVESD分别为(57.05±2.03)、(45.46±2.31)mm,均低于治疗2组[(59.59±1.16)、(47.77±3.07)mm],LVEF为(44.28±3.96)%,高于治疗2组[(35.91±3.85)%],差异均有统计学意义(P<0.05)。两组治疗后的24 h DBPV、24 h SBPV、24 h PR与治疗前相比均降低,且治疗1组治疗后24 h DBPV、24 h SBPV、24 h PR分别为(9.36±2.62)%、(10.21±3.01)%、(70.13±10.43),均低于治疗2组[(11.99±3.20)%、(13.44±3.62)%、(76.09±11.17)],差异均有统计学意义(P<0.05)。二元Logistic回归分析显示,年龄≥60岁、合并基础疾病≥2种、心功能分级Ⅳ级为低血压发生危险因素(P<0.05)。结论沙库巴曲缬沙坦治疗慢性心力衰竭合并低血压可有效改善患者心功能,动态血压监测血压变异性可辅助反映患者恢复效果,年龄≥60岁、合并基础疾病≥2种、心功能分级Ⅳ级为低血压发生危险因素。Objective To investigate the high-risk factors for the occurrence of hypotension and hypotension in chronic heart failure treated with blood pressure dynamic monitoring sakubatril valsartan.Methods A total of 106 patients with chronic heart failure combined with hypotension admitted to Qinhuangdao First Hospital from January 2020 to December 2022 were prospectively selected for the study,and the patients were divided into treatment group 1 and treatment group 2 according to the random number table method,with 53 cases in each group.Another 53 patients with chronic heart failure without hypotension admitted to our hospital in the same period were selected as the control group according to the ratio of 2∶1.All patients in treatment group 1 and treatment group 2 received standardized basic treatment for heart failure,while treatment group 1 was given oral treatment with sakubatril valsartan on the basis of treatment group 2,and both were treated continuously for 5 months.The cardiac function indexes[left ventricular end-diastolic internal diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic internal diameter(LVESD),heart rate],blood pressure indexes[24-hour mean pulse rate(24 h PR),24-hour mean systolic blood pressure variability(24 h SBPV),24-hour mean diastolic blood pressure variability(24 h DBPV)]were compared in the two groups,and the results were analyzed by binary Logistic regression analysis of factors influencing chronic heart failure combined with hypotension.Results After treatment,LVEDD,LVESD,and heart rate were lower and LVEF was higher in both groups compared with that before treatment,LVEDD and LVESD in group 1 were(57.05±2.03)and(45.46±2.31)mm,respectively,which were lower than those in group 2[(59.59±1.16)and(47.77±3.07)mm],and LVEF in group 1 was(44.28±3.96)%,which was higher than that in group 2[(35.91±3.85)%],the differences were statistically significant(P<0.05).After treatment,the 24 h DBPV,24 h SBPV,and 24 h PR were lower in both groups compared with t

关 键 词：慢性心力衰竭 沙库巴曲缬沙坦 低血压 血压动态监测 高危因素 

分 类 号：R541.6[医药卫生—心血管疾病] R544.2[医药卫生—内科学]