沙库巴曲缬沙坦在心力衰竭患者临床应用中的观察

戴聪; 邹凯; 曹杰; 吴丽娟; 徐正雄; 阮月华; 杨慧; 黎雨民; 胡龙龙; 杨人强

doi:10.13201/j.issn.1001-1439.2019.07.019

沙库巴曲缬沙坦在心力衰竭患者临床应用中的观察

- 南昌大学第二附属医院心内科(南昌,330006)
基金项目:
国家自然科学基金 (No:81660063)

国家十二五科技支撑计划 (No:2013BAI05B10)

详细信息

通讯作者: 杨人强, E-mail:yangrenqiangcn@163.com

中图分类号: R541.6

收稿日期: 2019-02-17

修回日期: 2019-04-20

An observation of the clinical application of sacubitril valsartan in patients with heart failure

- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, China

More Information

Corresponding author: YANG Ren-qiang, E-mail: yangrenqiangcn@163.com

Received Date: 17 February 2019

Revised Date: 20 April 2019

摘要

摘要: 目的:总结分析沙库巴曲缬沙坦在真实世界临床实际中治疗扩张型心肌病心力衰竭患者的情况、疗效和安全性。方法:本研究是一项前瞻性注册观察性研究。连续性纳入85例诊断为扩张型心肌病心力衰竭的患者, 首先给予患者血管紧张素转化酶抑制剂、β受体阻滞剂及醛固酮受体拮抗剂等进行常规治疗, 再停用血管紧张素转化酶抑制剂36h, 改用沙库巴曲缬沙坦钠片口服, 50mg/次, 2次/d, 根据患者的血压及耐受情况, 逐步调整剂量为400mg/d或至最大耐受量, 连续治疗12个月, 观察真实世界心力衰竭患者使用沙库巴曲缬沙坦治疗的剂量、治疗效果及其对患者血压、心脏结构和功能、血常规和肾功能等生化指标的影响。结果:沙库巴曲缬沙坦平均使用剂量为136.18mg/d, 治疗的总有效率为73%。患者治疗后左心室射血分数 (LVEF) 明显提高 (△<img id="2" type="formula" href="images/LCXB201907017_00200.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_00200.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=5.84%, P=0.000) , 左心室舒张末期内径 (LVEDD) (△<img id="3" type="formula" href="images/LCXB201907017_00300.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_00300.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=-3.05mm, P=0.000) 、收缩压 (△<img id="4" type="formula" href="images/LCXB201907017_00400.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_00400.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=-9.01mmHg, 1mmHg=0.133kPa, P=0.000) 、血红蛋白 (△<img id="5" type="formula" href="images/LCXB201907017_00500.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_00500.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=-8.14g/L, P=0.026) 均明显降低。治疗对患者肝肾功能及血脂无明显影响。结论:在真实世界的扩张型心肌病心力衰竭患者治疗中, 沙库巴曲缬沙坦使用剂量偏低, 但也可以取得较好的治疗效果。在使用过程中除了需要关注患者血压, 还需要关注血红蛋白的下降情况。
- 扩张型心肌病 /
- 沙库巴曲缬沙坦 /
- 血红蛋白
Abstract: Objective:To summarize and analyze the use, efficacy and safety of sacubitril valsartan in the treatment of heart failure patients with dilated cardiomyopathy in the real world clinical practice.Method:This study was a prospective registry observational study.A total of 50 patients diagnosed as dilated cardiomyopathy heart failure were continuously included.First, patients were given routine treatment including angiotensin converting enzyme inhibitors, βreceptor blockers, and aldosterone receptor antagonists.The angiotensin converting enzyme inhibitor was discontinued for 36 hours, then sacubitril valsartan was taken orally, 50 mg/time, twice a day, the dose was gradually adjusted to 400 mg/d or the maximum tolerance according to the patient's blood pressure and tolerance.For 12 consecutive months, the dose, therapeutic effect and biochemical indicators such as blood pressure, cardiac structure and function, blood routine and renal function of patients were observed.Result:The average dosage of sacubitril valsartan was 136.18 mg/d, and the total effective rate was 73%.After treatment, the left ventricular ejection fraction was significantly increased (△<img id="7" type="formula" href="images/LCXB201907017_00700.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_00700.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=5.84%, P=0.000) , while the left ventricular end-diastolic diameter (△<img id="8" type="formula" href="images/LCXB201907017_00800.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_00800.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=-3.05 mm, P=0.000) , systolic blood pressure (△<img id="9" type="formula" href="images/LCXB201907017_00900.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_00900.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=-9.01 mmHg, 1 mmHg=0.133 kPa, P=0.000) and hemoglobin (△<img id="10" type="formula" href="images/LCXB201907017_01000.jpg" display="inline" placement="inline" src="Detail/GetImg?filename=images/LCXB201907017_01000.jpg&uid=WEEvREcwSlJHSldSdmVqM1BLY1lPRlUxS1lmeUNYQXNqaUtyYm5OMzlCST0=$9A4hF_YAuvQ5obgVAqNKPCYcEjKensW4IQMovwHtwkF4VYPoHbKxJw!!" style="height: 22px;"> <alt></alt>=-8.14 g/L, P=0.026) were significantly decreased.The treatment had no significant effect on liver and kidney function and blood lipid.Conclusion:In the treatment of dilated cardiomyopathy patients with heart failure in the real world, the dosage of sakubatril valsartan is low, but it can also achieve a good therapeutic effect.It needs to pay attention to the blood pressure and the decline of hemoglobin in the treatment.
- dilated cardiomyopathy /
- sacubitril valsartan /
- hemoglobin

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