2020 年第 12 期 第 15 卷

沙库巴曲缬沙坦钠治疗急性心肌梗死后射血分数降低型心力衰竭的临床效果

Clinical effect of sacubitril valsartan sodium on heart failure with reduced ejection fraction after acute myocardial infarction

作者：段小春1王松涛2严研1李南3

英文作者：Duan Xiaochun1 Wang Songtao2 Yan Yan1 Li Nan3

单位：1首都医科大学附属北京安贞医院急诊危重症中心100029；2武警北京总队医院医务处100027；3首都医科大学附属北京安贞医院心内科100029

英文单位：1Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Medical Service Beijing Armed Police Corps Hospital Beijing 100027 China; 3Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China 

关键词：急性心肌梗死；射血分数降低型心力衰竭；沙库巴曲缬沙坦钠；依那普利

英文关键词：Acutemyocardialinfarction；Heartfailurewithreducedejectionfraction；Sacubitrilvalsartansodium；Enalapril

• 摘要：

• 目的  观察沙库巴曲缬沙坦钠治疗急性心肌梗死后射血分数降低型心力衰竭（HFrEF）的临床效果。方法 选取2019年1—10月首都医科大学附属北京安贞医院收治的急性心肌梗死后HFrEF患者98例，采用随机数字表法分为观察组（48例）和对照组（50例）。2组患者均给予抗血小板、调脂等冠状动脉粥样硬化性心脏病二级预防药物治疗及常规抗心力衰竭治疗，在此基础上，对照组口服马来酸依那普利，观察组口服沙库巴曲缬沙坦钠，2组均连续治疗6个月。比较治疗前后2组患者心功能指标、血浆N末端B型脑钠肽前体（NT-proBNP）、估算肾小球滤过率(eGFR)、血清钾离子水平、6 min步行试验（6MWT）距离和明尼苏达心力衰竭生存质量量表（MLHFQ）评分。记录治疗期间再住院率、平均住院时间。结果治疗后，2组左心室射血分数均高于治疗前，且观察组高于对照组［(49±6)%比(44±6)%］，差异均有统计学意义（均P<0.01）；2组NT-proBNP水平均低于治疗前，且观察组低于对照组［(395±50)ng/L比(659±81)ng/L］（均P<0.05）。治疗前后2组eGFR、血清钾离子水平比较差异均无统计学意义(均P>0.05)。治疗后2组6MWT距离均高于治疗前，且观察组高于对照组［(350±33)m比(301±30)m］,MLHFQ评分均低于治疗前，且观察组低于对照组［(15±5)分比(18±6)分］,差异均有统计学意义（均P<0.05）。治疗期间观察组因心力衰竭再住院率低于对照组［22.9%（11/48）比38.0%（19/50）］、平均住院时间短于对照组［（9.5±2.0）d比（12.2±3.3）d］，差异均有统计学意义（均P＜0.05）。结论 沙库巴曲缬沙坦钠片能安全有效地改善急性心肌梗死后HFrEF患者的心功能状况，提高运动耐力和生活质量。

• Objective To observe the clinical effect of sacubitril valsartan sodium on the treatment of  heart failure with reduced ejection fraction(HFrEF) after acute myocardial infarction (AMI). Methods From January  to October 2019, 98 patients with HFrEF after AMI admitted to Beijing Anzhen Hospital, Capital Medical University were selected. The patients were randomly divided into observation group (48 cases) and control group (50 cases). Both groups were given antiplatelet, lipid-lowering and other secondary prevention of drug treatment for coronary atherosclerotic heart disease and conventional anti-heart failure treatment. On this basis, the control group was given enalapril maleate orally, and the observation group was given sacubitril/valsartan sodium orally, both groups were treated continuously for 6 months. The cardiac function indexes, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), serum potassium level, 6 minutes walk test (6MWT) distance and Minnesota living with heart failure questionnaire (MLHFQ) score were compared between the two groups before and after treatment. The rate of rehospitalization and average length of hospital stay were recorded during treatment. Results After treatment, the left ventricular ejection fraction（LVEF） in both groups were higher than those before treatment, and LVEF of observation group was higher than that of control group ［(49±6)% vs (44±6)%］（all P<0.01）. After treatment the levels of NT-proBNP in both groups were lower than those before treatment, and NT-proBNP in the observation group was lower than that in control group［(395±50)ng/L vs (659±81)ng/L］（all P<0.05）. There were no significant differences in levels of eGFR and serum potassium between the two groups before and after treatment (all P>0.05). After treatment, the distance of 6MWT in both groups were longer than those before treatment and that in observation group was longer than that in control group［(350±33)m vs (301±30)m］; the scores of MLHFQ of both groups were lower than before treatment and that of observation group was lower than that of control group［(15±5) vs (18±6)］（all P<0.05）. The rate of rehospitalization in observation group was lower than that in control group［22.9%(11/48) vs 38.0%(19/50)］, and the average length of hospital stay in observation group was shorter than that in the control group ［(9.5±2.0)d vs (12.2±3.3)d］ (both P<0.05). Conclusion Sacubitril valsartan sodium can improve cardiac function, exercise endurance and quality of life in patients with HFrEF after AMI.