沙库巴曲缬沙坦治疗急性心肌梗死PCI术后合并慢性心力衰竭的临床效果

目的 探讨沙库巴曲缬沙坦应用于急性心肌梗死经皮冠状动脉介入(PCI)后合并心力衰竭中的临床效果。方法 前瞻性选取内蒙古民族大学第二临床医学院心内科2020年1—6月收治的60例急性心肌梗死PCI术后合并慢性心力衰竭患者作为研究对象；采用数字双盲分组法将病例分为试验组(n=30)和对照组(n=30)；对照组采用常规抗心力衰竭治疗，试验组则将ACEI/ARB类药物替换为沙库巴曲缬沙坦，比较两组患者治疗前后不同时间段血浆N-末端前体B型钠尿肽(NT-proBNP)水平、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、KCCQ评分，并比较不良反应发生率及再次入院率。 结果 随访显示，试验组患者治疗后6个月的NT-proBNP、LVEDD明显低于对照组，LVEF明显高于对照组，差异有统计学意义(P＜0.05)；试验组治疗后4、6个月的KCCQ量表评分高于对照组，差异有统计学意义(P＜0.05)；随访6个月，试验组患者的再次入院率低于对照组，差异有统计学意义(P＜0.05)，两组不良反应总发生率比较，差异无统计学意义(P＞0.05)。 结论 在急性心肌梗死PCI术后合并慢性心力衰竭患者的治疗中使用沙库巴曲缬沙坦可取得理想的治疗效果，该方法安全有效，值得在临床实践中借鉴并推广。

Clinical effect of sacubitril and valsartan in treatment of acute myocardial infarction combined with heart failure after PCI

Objective To investigate the clinical effect of sacubitril and valsartan in patients with acute myocardial infarction combined with heart failure after percutaneous coronary intervention (PCI). Methods A total of 60 patients with acute myocardial infarction combined with chronic heart failure after PCI and treated in the Department of Cardiology of the Second Clinical Medical School of Inner Mongolia University for Nationalities from January to June 2020 were selected prospectively. They were divided into the experimental group (n=30) and the control group (n=30) using digital double-blind grouping method. The control group were treated with conventional anti-heart failure treatment, while the experimental group were given sacubitril and valsartan in replacement of ACEI/ARB medications. Plasma N-terminal precursor B-type natriuretic peptide (NT-proBNP) levels, left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) and KCCQ score were compared between 2 groups at different time points before and after treatment, and the rate of adverse reactions and readhospital rate were compared. Results Follow-up showed that, at 6 months after treatment, the levels of NT-proBNP and LVEDD of the experimental group were significantly lower than those of the control group, and the level of LVEF was significantly higher than that of the control group, with statistically significant differences (P<0.05). At 4 and 6 months after treatment, the scores of Kansas city cardiomyopathy questionnaire (KCCQ) of the experimental group were higher than those of the control group, with statistically significant differences (P<0.05). At 6 months of follow-up, the readmission rate of the experimental group was lower than that of the control group, with statistically difference (P<0.05). There was no statistically significant difference in total adverse event rate between the two groups (P>0.05). Conclusion The application of sacubitril and valsartan has ideal therapeutic effect in the treatment of patients with acute myocardial infarction combined with chronic heart failure after PCI. It is safe and effective and is worthy of reference and promotion in clinical practice.