沙库巴曲缬沙坦对心力衰竭合并肺动脉高压患者右心室功能的影响  

Effects of sacubitril/valsartan on the right ventricular function in patients with heart failure complicated with pulmonary hypertension

作　　者：刘蕊 沃金善[1] 赵亮[2] 苏哲[3] 姚来昱 李培慧 LIU Rui;WO Jinshan;ZHAO Liang;SU Zhe;YAO Laiyu;LI Peihui(Department of Cardiovascular Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong,China;Department of Cardiac Ultrasound,the Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong,China;Department of Emergency,the Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong,China)

机构地区：[1]青岛大学附属医院心内科,山东青岛266003 [2]青岛大学附属医院心脏超声科,山东青岛266003 [3]青岛大学附属医院急诊科,山东青岛266003

出　　处：《中国现代医生》2023年第23期55-58,63,共5页China Modern Doctor

基　　金：山东省医药卫生科技发展计划项目(2019WS372)。

摘　　要：目的利用超声心动图评价沙库巴曲缬沙坦对心力衰竭(以下简称心衰)合并肺动脉高压患者右心室功能的影响。方法前瞻性观察2020年9月至2021年3月于青岛大学附属医院确诊的心衰合并肺动脉高压的患者50例。根据心衰用药情况的不同,分为观察组(n=27)和对照组(n=23)。对照组在常规治疗的基础上应用缬沙坦,观察组在常规治疗的基础上应用沙库巴曲缬沙坦。利用超声心动图评价并比较治疗前和治疗6个月时患者的右心室功能参数[三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、右心室面积变化分数(fractional area change,FAC)、三尖瓣瓣环收缩期峰值速度(peak systolic myocardial velocity of tricuspid valve annulus,S’)]、右心室–肺动脉耦联参数[肺动脉收缩压(pulmonary artery systolic pressure,PASP)、三尖瓣环收缩期位移/肺动脉收缩压比值(TAPSE/PASP,T/P)]、左心重构指标[左房内径(left atrium diameter,LAD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室射血分数(left ventricular ejection fraction,LVEF)]的变化情况。结果治疗前,两组TAPSE、S’、FAC、PASP、T/P比值、LAD、LVEDD、LVESD、LVEF比较,差异均无统计学意义(P>0.05)。治疗6个月后,两组TAPSE、S’、T/P比值、LVEF均显著高于治疗前(P<0.05),PASP显著低于治疗前(P<0.05),LVEDD、LVESD显著小于治疗前(P<0.05)。对照组FAC、LAD与治疗前比较,差异均无统计学意义(P>0.05)。治疗后观察组TAPSE、S’、FAC、PASP、T/P比值、LAD、LVEDD、LVESD、LVEF的改善程度均显著优于对照组(P<0.05)。结论与缬沙坦相比,沙库巴曲缬沙坦不仅能改善心衰合并肺动脉高压患者左心重构,亦可有效改善右心室收缩功能,降低肺动脉压力,并对右心室–肺动脉耦联起到一定程度的改善作用。Objective To observe the effects of sacubitril/valsartan on the right ventricular function in patients with heart failure complicated with pulmonary hypertension.Methods A total of 50 patients with heart failure combined with pulmonary hypertension diagnosed at the Affiliated Hospital of Qingdao University from September 2020 to March 2021 were prospectively observed.According to the difference of heart failure medication,they were divided into the observation group(n=27)and the control group(n=23).The control group applied valsartan on the basis of general treatment,and the observation group applied sacubitril valsartan on the basis of general treatment.Echocardiography was used to evaluate and compare the patients’right ventricular functional parameters[tricuspid annular plane systolic excursion(TAPSE),fractional area change(FAC),peak systolic myocardial velocity of tricuspid valve annulus(S’)],right ventricle-pulmonary artery coupling parameters[pulmonary artery systolic pressure(PASP),TAPSE/PASP(T/P)],and left heart remodelling indices[left atrium diameter(LAD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF)]before the treatment and at the end of 6 months of treatment.Results Before treatment,TAPSE,S’,FAC,PASP,T/P ratio,LAD,LVEDD,LVESD,LVEF were compared between the two groups,and the differences were not statistically significant(P>0.05).After 6 months of treatment,TAPSE,S’,T/P ratio,and LVEF were significantly higher than before treatment in both groups(P<0.05),PASP was significantly lower than before treatment(P<0.05),and LVEDD,LVESD were significantly smaller than before treatment(P<0.05).In the control group,FAC and LAD were not statistically significant when compared with those before treatment(P>0.05).The improvement of TAPSE,S’,FAC,PASP,T/P ratio,LAD,LVEDD,LVESD,and LVEF in the observation group was significantly better than those in the control group after treatment(P<0.05).Conclusion Compared with val

关 键 词：沙库巴曲缬沙坦 慢性心力衰竭 肺动脉高压 右心室功能 右心室–肺动脉耦联 

分 类 号：R541.6[医药卫生—心血管疾病] R544.1[医药卫生—内科学]