黄志勇

[關键词] 血液透析;慢性肾衰竭;心力衰竭;沙库巴曲缬沙坦;肌钙蛋白

[中图分类号] R541          [文献标识码] B          [文章编号] 1673-9701（2021）17-0099-04

Therapeutic efficacy of sacubitril valsartan sodium tablets on chronic heart failure in patients with maintenance hemodialysis

HUANG Zhiyong

Department of Nephrology， the People′s Hospital of Macheng City in Hubei Province， Macheng    438300， China

[Abstract] Objective To observe the therapeutic efficacy of sacubitril valsartan sodium tablets on chronic heart failure in patients with maintenance hemodialysis. Methods A total of 70 maintenance hemodialysis patients with chronic heart failure admitted to and treated in the Department of Nephrology of Macheng People′s Hospital from January 2019 to June 2020 were analyzed retrospectively. They were divided into the control group and the treatment group， with 35 cases in each group. The index changes of 6-minute walk test （6MWT）， left ventricular end systolic diameter （LVESD）， left ventricular end diastolic diameter （LVEDD）， left ventricular ejection fraction （LVEF）， N terminal pro B type natriuretic peptide （NT-proBNP）， cardiac troponin T （cTnT）， cardiac troponin I （cTnI）， hypersensitive C-reactive protein （hs-CRP） and K+ were compared between the two groups. Results 1.The distance of 6MWT in the treatment group was （386.72±68.48） min， which was longer than that of （339.59±69.39） min in the control group， with statistically significant difference （P<0.05）. 2.LVESD and LVEDD in the treatment group were （43.25±5.23） mm and （47.85±9.69） mm， which were significantly lower than those of （47.89±7.15）mm and（50.52±9.78） mm in the control group， with statistically significant differences（P<0.05）. The LVEF in the treatment group was （48.99±4.16）%， which was significantly higher than that of （40.73±3.75）% in the control group， with statistically significant difference（P<0.05）. 3.The NT-proBNP， cTnT， cTnI and hs-CRP in the treatment group were significantly lower than those in the control group， with statistically significant differences （P<0.05）. There was no statistically significant difference of K+ between the treatment group and the control group （P>0.05）. Conclusion Sacubitril valsartan sodium tablets can obviously improve ventricular remodeling in maintenance hemodialysis patients with chronic heart failure， and the therapeutic efficacy is reliable and safe to use.

[Key words] Hemodialysis; Chronic renal failure; Heart failure;Sacubitril valsartan sodium tablets; Troponin

慢性心力衰竭是各种原因导致心脏结构与功能损伤，影响心脏射血能力导致体循环、肺循环淤血的临床综合征，是临床常见的急危重症[1]。慢性心力衰竭是维持性血液透析患者常见并发症之一，单纯血液透析只能改善心衰容量负荷过重，药物是治疗慢性心力衰竭的主要手段;沙库巴曲缬沙坦片是血管紧张素受体脑啡肽酶抑制剂（Angiotension receptor/enkephalinase inhibitor，ARNI），是治疗慢性心力衰竭的新型药物。其化学结构包含脑啡肽酶抑制剂沙库巴曲和血管紧张素Ⅱ受体拮抗剂（Angiotensin Ⅱ receptor blocker，ARB）类药物缬沙坦[2]。沙库巴曲缬沙坦片在维持性血液透析合并慢性心力衰竭患者中应用鲜有报道，本研究旨在观察沙库巴曲缬沙坦片在维持性血液透析合并慢性心力衰竭患者疗效，现报道如下。

1 资料与方法

1.1 一般资料

收集2019年1月至2020年6月麻城市人民医院肾内科维持性血液透析患者并发不同程度的慢性心力衰竭70例，纳入标准：①符合《中国心力衰竭诊断和治疗指南2018》慢性心力衰竭诊断标准[3];②有慢性心力衰竭症状，符合纽约心脏病学会心功能分级≥Ⅱ级;③年龄30～78岁;④慢性肾衰竭[估算的肾小球滤过率（Estimated  glomerular  filtration rate，eGFR）：15 mL/（min·1.73 m2）]并已行血液透析。排除标准：①入组前72 h内有用血管紧张素转化酶抑制剂（Angiotensin converting enzyme inhibitors，ACEI）或ARB类药物史者;②严重高钾血症，血钾≥6.2 mmol/L者;③肾动脉狭窄者;④肿瘤、结核者;⑤严重肝功能障碍者;⑥过敏体质者;⑦资料不全或不配合治疗者。采用随机数字表法將入选患者分为治疗组和对照组，每组各35例，所有患者均已签署知情同意书，本研究已通过麻城市人民医院医学伦理委员会批准。……