2024 年第 9 期 第 19 卷

沙库巴曲缬沙坦联合基础治疗对慢性心力衰竭患者血液流变学和心功能状态及运动耐力的影响

Effects of sacubitril/valsartan combined with basic therapy on hemorheology, cardiac function status and exercise tolerance in patients with chronic heart failure

作者：吴茜何春杨徐超然

英文作者：Wu Qian He Chunyang Xu Chaoran

单位：西南交通大学附属医院成都市第三人民医院药学部，成都610031

英文单位：Department of Pharmacy the Third People′s Hospital of Chengdu Affiliated Hospital of Southwest Jiaotong University Chengdu 610031 China

关键词：慢性心力衰竭；沙库巴曲缬沙坦；血液流变学；心功能状态；运动耐力

英文关键词：Chronicheartfailure;Sacubitril/valsartan;Hemorheology;Cardiacfunctionstatus;Exercisetolerance

• 摘要：

• 目的 探究沙库巴曲缬沙坦联合基础治疗对慢性心力衰竭（CHF）患者血液流变学、心功能状态及运动耐力的影响。方法 选取2019年4月至2023年4月成都市第三人民医院收治的114例CHF患者，采用区组随机化分组法分为观察组和对照组，各57例。对照组接受常规CHF基础治疗用药，观察组在此基础上给予沙库巴曲缬沙坦联合治疗。比较2组患者治疗6个月后的临床效果，包括心功能状态［左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）］、血液流变学指标［全血黏度、血浆黏度、红细胞变形指数（DI）］、运动耐力［6 min步行试验（6MWT）距离和峰值摄氧量］。记录2组患者治疗期间不良反应发生情况。结果 治疗6个月后，观察组总有效率高于对照组［84.2%（48/57）比68.4%（39/57）］，差异有统计学意义（P=0.047）。治疗6个月后，2组心功能状态LVEDV和LVESV均低于治疗前，且观察组均低于对照组［（222±4）ml比（226±5）ml、（100±4）ml比（102±5）ml］（均P＜0.05）。治疗6个月后，2组血液流变学指标全血黏度、血浆黏度均低于治疗前，且观察组均低于对照组［（3.1±1.0）mPa·s比（3.7±1.1）mPa·s、（1.2±1.0）mPa·s比（1.9±1.1）mPa·s］，DI均高于治疗前，且观察组高于对照组［（0.51±0.23）比（0.41±0.24）］（均P＜0.05）。治疗6个月后，2组运动耐力中6MWT距离和峰值摄氧量长于/高于治疗前，且观察组长于/高于对照组［（509±6）m比（501±6）m、（22.4±2.9）ml/(kg·min）比（20.7±3.8）ml/(kg·min）］（均P＜0.05）。治疗期间，2组患者不良反应发生率比较差异无统计学意义（P=0.297）。结论 沙库巴曲缬沙坦联合基础治疗CHF效果显著，使患者血液流变学趋于正常，对心功能状态和运动耐力具有积极改善作用。

• Objective To investigate the effects of sacubitril/valsartan combined with basic therapy on hemorheology, cardiac function status and exercise tolerance in patients with chronic heart failure(CHF). Methods A total of 114 CHF patients admitted to the Third People′s Hospital of Chengdu from April 2019 to April 2023 were selected and divided into observation group and control group by block randomization method, with 57 cases in each group.The control group received conventional CHF basic treatment, and the observation group was given sacubitril/valsartan combined treatment on this basis.The clinical effects of the two groups were compared after 6 months of treatment. Including heart function ［left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV)］, hemorheology indexs ［whole blood viscosity, plasma viscosity, erythrocyte deformation index (DI)］, sports endurance ［6 min walking distance test (6MWT) and peak oxygen uptake］. The occurrence of adverse reactions of patients in the two groups during treatment was recorded. Results After 6 months of treatment, the total effective rate of the observation group was higher than that of the control group ［84.2%(48/57) vs 68.4%(39/57)］(P=0.047). After 6 months of treatment, the LVEDV and LVESV of the two groups were lower than those before treatment, and those of the observation group were lower than those of the control group［(222±4)ml vs (226±5)ml, (100±4)ml vs (102±5)ml］(all P＜0.05). After 6 months of treatment, the hemorheological indexes of whole blood viscosity and plasma viscosity in the two groups were lower than those before treatment, and the observation group were lower than the control group ［(3.1±1.0)mPa·s vs (3.7±1.1)mPa·s, (1.2±1.0)mPa·s vs (1.9±1.1)mPa·s］; DI was higher than that before treatment, and the observation group was higher than the control group［(0.51±0.23) vs (0.41±0.24)］(all P＜0.05). After 6 months of treatment, the 6MWT distance and peak oxygen uptake in exercise tolerance of the two groups were longer/higher than those before treatment, and those in the observation group were longer/higher than those in the control group ［(509±6)m vs (501±6)m, (22.4±2.9)ml/(kg·min) vs (20.7±3.8)ml/(kg·min)］(all P＜0.05). During the treatment period, there was no statistically significant difference in the incidence of adverse reactions between the two groups of patients(P=0.297). Conclusion Sacubitril/valsartan combined with basic therapy has a significant effect on CHF, which makes the hemorheology of patients tend to be normal, and has a positive effect on the improvement of cardiac function and exercise endurance.