沙库巴曲缬沙坦对心房颤动射频消融术后病人心脏重构及生活质量影响  

Effect of sacubitril valsartan sodium tablets on cardiac remodeling reversal and quality of life in patients after radiofrequency ablation for atrial fibrillation

作　　者：张振岭 刘利月 李俊艳 龙敬宁 王建铭 刘辉[1] ZHANG Zhenling;LIU Liyue;LI Junyan;LONG Jingning;WANG Jianming;LIU Hui(Department of Cardiology,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院心血管内科,河南新乡453100 [2]新乡医学院第一附属医院临床药学学部,河南新乡453100 [3]新乡医学院第一附属医院CCU,河南新乡453100

出　　处：《青岛大学学报(医学版)》2024年第6期898-902,共5页Journal of Qingdao University(Medical Sciences)

基　　金：河南省医学科技攻关计划项目(LHGJ2021-0503)。

摘　　要：目的探讨沙库巴曲缬沙坦(诺欣妥)对心房颤动(房颤)射频消融术后病人心脏重构逆转的作用及其对病人生活质量的影响。方法2021年1月—2022年8月,前瞻性选取于新乡医学院第一附属医院因持续性房颤而行射频消融术治疗的158例病人为研究对象,采用简单随机分组方法将其分为观察组和对照组(各79例),对照组术后接受盐酸胺碘酮口服治疗,观察组术后在对照组用药基础上联合诺欣妥治疗。随访1年后比较两组临床疗效、治疗前后心脏重构逆转(左房容积指数(LAVI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI))、心功能(B型利钠肽前体N末端(NT-proBNP)、左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD))、生活质量变化以及房颤复发率等指标。结果治疗后观察组总有效率(92.4%)高于对照组(78.5%),观察组12个月内房颤复发率(31.6%)明显低于对照组(53.2%),且明尼苏达心力衰竭(心衰)生活质量问卷(MLHFQ)的疾病情况、体力状况、情绪状态和社会关系等维度评分均明显低于对照组,差异均有统计学意义(Z=2.446,χ^(2)=7.489,t=19.380~54.664,P<0.05)。治疗前两组病人心脏重构和心功能相关指标比较,差异均无统计学意义(t=0.092~1.223,P>0.05)。治疗后,两组病人心脏重构指标(LAVI、LVEDVI和LVESVI)均显著下降(t=7.149~11.829,P<0.05),但观察组的治疗后各指标及其治疗前后差值均显著低于对照组(t=3.237~20.289,P<0.05);两组心功能指标LVEF均显著上升,而LVESD、LVEDD和NT-proBNP等均显著下降(t=2.572~18.059,P<0.05),但观察组的治疗后各指标及其治疗前后差值的改善均较对照组更显著(t=2.759~40.210,P<0.05)。结论诺欣妥对因持续性房颤而行消融术治疗的病人有较好效果,能有效逆转病人心脏重建,改善病人心功能和生活质量,降低房颤复发率。Objective To investigate the effect of sacubitril valsartan sodium tablets(Entresto)on reversing cardiac remode-ling and improving quality of life in patients after radiofrequency ablation for atrial fibrillation.Methods From January 2021 to August 2022,a prospective study was conducted from 158 patients who underwent radiofrequency ablation for persistent atrial fibrillation in the First Affiliated Hospital of Xinxiang Medical College,and they were divided into observation group and control group using the simple randomization method,with 79 patients in each group.The patients in the control group were given oral administration of amiodarone hydrochloride tablets after surgery,while those in the observation group received Entresto in addition to the treatment in the control group after surgery.After follow-up for 1 year,the two groups were compared in terms of clinical outcome,reversal of cardiac remodeling after treatment(left atrial volume index(LAVI),left ventricular end-diastolic volume index(LVEDVI),and left ventricular end-systolic volume index(LVESVI)),cardiac function(N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),and left ventricular end-diastolic diameter(LVEDD)),quality of life before and after treatment,and the recurrence rate of atrial fibrillation.Results Compared with the control group after treatment,the observation group had a significantly higher overall response rate(92.4%vs 78.5%,Z=2.446,P<0.05),a significantly lower recurrence rate of atrial fibrillation within 12 months(31.6%vs 53.2%,χ^(2)=7.489,P<0.05),and significantly lower scores of the dimensions of overall functioning,physical functioning,emotional functioning,and social functioning in Minnesota Living with Heart Failure Questionnaire(t=19.380-54.664,P<0.05).Before treatment,there were no significant differences in cardiac remodeling parameters and car-diac function parameters between the two groups(t=0.092-1.223,P>0.05).After treatment,both g

关 键 词：心房颤动 导管消融术 脑啡肽酶 缬沙坦 胺碘酮 超声心动描记术 多普勒 生活质量 

分 类 号：R541.75[医药卫生—心血管疾病] R972.2[医药卫生—内科学]