沙库巴曲缬沙坦钠联合呋塞米治疗高血压伴慢性心力衰竭的临床疗效

摘要/Abstract

摘要： 目的：探讨沙库巴曲缬沙坦钠联合呋塞米治疗高血压伴慢性心力衰竭（CHF）的疗效及对心功能、炎症因子水平的影响。方法：选择2021年3月至2022年3月我院收治的100例高血压伴CHF患者展开研究，用简单随机数字表法将其分为观察组和对照组，每组各50例。对照组患者给予呋塞米治疗，观察组患者给予沙库巴曲缬沙坦钠+呋塞米联合治疗。治疗3个月后，比较两组患者临床疗效。记录患者治疗前后心功能[左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）]、血压（舒张压、收缩压、心率）、血清炎症因子[N末端脑钠肽前体（NT-proBNP）、C反应蛋白（CRP）、血清肿瘤坏死因子-α（TNF-α）、心肌肌钙蛋白I（cTnI）]水平变化，记录两组患者不良反应。结果：观察组患者治疗总有效率为96.00%，高于对照组的80.00%（P<0.05）。治疗后，两组患者的LVEDD、LVESD水平均降低，观察组患者降低幅度大于对照组；两组患者LVEF水平均升高，观察组患者升高幅度大于对照组（P<0.05）。治疗后，两组患者的舒张压、收缩压、心率均降低，且观察组患者的降低幅度大于对照组（P<0.05）。治疗后，两组患者血清NT-proBNP、CRP、cTnI、TNF-α指标水平均降低，且观察组患者的降低幅度大于对照组（P<0.05）。两组患者不良反应发生率差异无统计学意义（P>0.05）。结论：沙库巴曲缬沙坦钠联合呋塞米治疗高血压伴CHF效果理想，可有效改善患者心功能，有效降低血清炎症因子水平，且不会增加不良反应。

关键词: font-size:medium, ">高血压；慢性心力衰竭；沙库巴曲缬沙坦钠；呋塞米；疗效；不良反应

Abstract: Objective： To investigate the efficacy of combination therapy with sacubitril valsartan sodium and furosemide in the treatment of hypertension patients with chronic heart failure (CHF) and its effects on cardiac function and inflammatory factors levels. Methods：A total of 100 hypertension patients with CHF admitted in our hospital from March 2021 to March 2022 were selected， and were divided into the observation group and the control group according to random number table method， with 50 cases in each group. The control group was treated with furosemide， and the observation group was treated with sacubitril valsartan sodium and furosemide. After 3 months of treatment， the clinical efficacy of the two groups was compared. The levels of cardiac function indicators [left ventricular end diastolic diameter (LVEDD)， left ventricular end systolic diameter (LVESD)， left ventricular ejection fraction (LVEF)]， blood pressure (diastolic pressure， systolic pressure， heart rate)， serum inflammatory factors [NT-proBNP， C-reactive protein (CRP)， serum tumor necrosis factor-α(TNF-α)， cardiac troponin I (cTnI))] were recorded before and after the treatment， and the adverse reactions were recorded for both groups. Results： The total effective rate of the observation group was 96.00%， which was higher than that of the control group (80.00%， P<0.05). After the treatment， the levels of LVEDD and LVESD of patients in both groups decreased， and the observation group was lower than the control group， while the level of LVEF of both groups increased， and the observation group was higher than the control group (P<0.05). After treatment， the diastolic blood pressure， systolic blood pressure， and heart rate of patients in both groups decreased， and the observation group was lower than the control group (P<0.05). After treatment， the serum NT-proBNP， CRP， cTnI， and TNF-α levels of patients in both groups decreased， and the observation group was lower than the control group (P<0.05).There was no statistical difference in the incidence of adverse reactions between the observation group and the control group (P>0.05). Conclusion：The combination therapy of sacubitril valsartan sodium and furosemide has an ideal effect on the treatment of hypertension patients with CHF， which can effectively improve the patient′s heart function， reduce serum inflammatory factor levels， and do not increase adverse reactions.

Key words: font-size:medium, ">Hypertension； Chronic heart failure； Sacubitril valsartan sodium； Furosemide； Efficacy； Adverse reactions

中图分类号:

陆燕, 刘凯, 周航, 陈启稚. 沙库巴曲缬沙坦钠联合呋塞米治疗高血压伴慢性心力衰竭的临床疗效[J]. 中国医药导刊, 2023, 25(7): 756-761.

LU Yan, LIU Kai, ZHOU Hang, CHEN Qizhi. The Clinical Efficacy of Combination Therapy with Sacubitril Valsartan Sodium and Furosemide in the Treatment of Hypertension Patients with Chronic Heart Failure[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2023, 25(7): 756-761.

参考文献

[1]韩蓓蓓，沈成兴.高血压并慢性心力衰竭的诊治新进展[J]. 世界临床药物， 2019，40(7)：461-469.
     [2]高源，李嫣红，郑刚.沙库巴曲缬沙坦治疗心力衰竭的研究进展[J]. 中西医结合心脑血管病杂志，2021，19(17)：2947-2951.
     [3]Manukyan MA， Falkovskaya AY， Zyubanova IV， et al. Diastolic dysfunction and heart failurewith preserved ejection fraction in patients with resistant hypertension and type 2 diabetes mellitus[J]. Kardiologiia， 2022， 62(8)：11-18.
     [4]彭文近，李彤，刘迎午，等.沙库巴曲缬沙坦联合重组人脑利尿钠肽治疗高血压伴心力衰竭患者的临床疗效[J]. 中华高血压杂志，2021，29(6)：572-575.
     [5]刘倩，孟芳芳.托拉塞米与呋塞米联合贝那普利治疗高血压合并慢性心力衰竭的疗效对比研究[J]. 山西医药杂志，2022，51(8)：902-904.
     [6]中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018 [J]. 中华心血管病杂志， 2018，46(10)：760-780.
     [7]《中国高血压防治指南》修订委员会.中国高血压防治指南2018年修订版[J]. 心脑血管病防治，2019，19(1)：1-44.
     [8]王蔚文.临床疾病诊断与疗效判断标准[M]. 北京：科学技术文献出版社，2010：247-249.
     [9]Dzudie A， Kengne AP， Mbahe S， et al. Chronic heart failure， selected risk factors and co-morbidities among adults treated for hypertension in a cardiac referral hospital in Cameroon[J]. Eur J Heart Fail， 2020， 10(4)：367-372.
     [10]马红红，张启龙，马艳梅.沙库巴曲缬沙坦对老年高血压合并HFrEF患者疗效，心功能及预后的影响[J]. 海南医学，2023，34(2)：210-213.
     [11]王心悦.美托洛尔联合沙库巴曲缬沙坦钠片对高血压合并慢性心力衰竭患者心脏彩超及NT-proBNP水平的影响[J]. 中国现代药物应用，2020，14(24)：155-157.
     [12]Kakehi K， Iwanaga Y， Watanabe H， et al. Modulation of sympathetic activity and innervation with chronic ivabradine and β-blocker therapies： analysis of hypertensive rats with heart failure[J]. J Cardiovasc Pharmacol Ther， 2019， 24(4)：387-396.
     [13]程明月，张辉，徐晤，等.沙库巴曲缬沙坦联合呋塞米治疗慢性心力衰竭的疗效研究[J]. 现代生物医学进展，2019，19(22)：4295-4298.
     [14]刘艳梅，李红旗，庞可心.沙库巴曲缬沙坦联合螺内酯治疗慢性心力衰竭对左室射血分数及血浆NT-proBNP的影响[J]. 湖南师范大学学报（医学版），2021，18(4)：44-47.
     [15]Rossignol P， Williams B， Mayo MR， et al. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER)：results in the pre-specified subgroup with heart failure[J]. Eur J Heart Fail， 2020， 22(8)：1462-1471.
     [16]孟雅杰，陈嘉怡，李敬超，等.沙库巴曲缬沙坦钠片治疗冠心病合并慢性心力衰竭的疗效及对患者心功能与炎性因子水平的影响[J]. 海南医学，2023，34(5)：621-624.
     [17]赵金艳，崔少楠，曹月娟.沙库巴曲缬沙坦钠治疗老年高血压慢性心力衰竭的疗效观察[J]. 中华老年心脑血管病杂志，2021，23(12)：1268-1271.
     [18]Brzyzkiewicz H， Konduracka E， Gajos G， et al. Incidence of chronic heart failure with preserved left ventricular ejection fraction in patients with hypertension and isolated mild diastolic dysfunction[J]. Pol Arch Med Wewn，2021，12(2)：12-18.
     [19]张子健，乔香玲，李晓增，等.沙库巴曲缬沙坦治疗高血压合并慢性心力衰竭患者的疗效以及对AngⅡ、FGF23水平的影响[J]. 中国循证心血管医学杂志，2022，14(9)：1091-1094.
     [20]Donahoe L， McRae K， Asghar U， et al. Central venoarterial extracorporeal membrane oxygenation as a bridge to recovery after pulmonary endarterectomy in patients with decompensated right heart failure[J]. J Heart Lung Transplant， 2022， 41(6)：773-779.

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