沙库巴曲缬沙坦钠治疗急性心肌梗死后心力衰竭效果观察

目的 观察沙库巴曲缬沙坦钠治疗急性心肌梗死后心力衰竭的效果，使其更好改善预后。 方法 纳入急性心肌梗死伴有心力衰竭且经皮冠状动脉介入治疗患者86例，据临床治疗方法不同分为对照组（贝那普利）和观察组（沙库巴曲缬沙坦钠），每组43例。比较2组术后3个月心脏超声指标［左心室收缩末期容积（left ventricular end-systolic volume，LVESV）、左心室舒张末期容积（left ventricular end-diastolic volume，LVEDD）、左心室射血分数（left ventricular ejection fraction LVEF）、每搏输出量（stroke volume,SV）］、血清学炎症因子变化［超敏C反应蛋白［（high sensitivity C-reactive protein，hs-CRP）和白细胞介素6（interleukin-6，IL-6）］、N末端B型利钠肽原（N-terminalpro-B-type natriuretic peptide,NT-proBNP）、6 min步行实验、不良反应发生率、预后及转归等。 结果 治疗后，2组LVESV、LVEDD低于治疗前，LVEF、SV高于治疗前，观察组LVESV、LVEDD低于对照组，LVEF、SV高于对照组，差异有统计学意义（P＜0.05）。2组hs-CRP、IL-6、NT-proBNP水平低于治疗前，观察组hs-CRP、IL-6、NT-proBNP水平低于对照组，差异有统计学意义（P＜0.05）。2组低血压、高钾血症、肾功能不全不良反应发生率差异无统计学意义（P＞0.05）。2组再发心肌梗死、室性心动过速/频发室性期前收缩、心源性猝死差异无统计学意义（P＞0.05）；观察组心力衰竭再住院率低于对照组，6 min步行实验长于对照组，差异有统计学意义（P＜0.05）。 结论 与贝那普利相比，沙库巴曲缬沙坦可改善心肌梗死后心力衰竭左心室心功能、左心室重塑，增强其活动耐量，降低心力衰竭再住院率，但并不增加不良反应及不良心血管事件发生率。

Observation on the effect of Sacubitril/valsartan in the treatment of patients with heart failure after acute myocardial infarction

Objective To observe the effect of Sacubitril/valsartan, in comparison to benazepril, in the treatment of patients with heart failure after acute myocardial infarction(AMI), so as to improve the prognosis.Methods A total of 86 patients with heart failure after AMI undergoing percutaneous coronary intervention(PCI) were selected. According to different treatment methods, they were divided into control group(benazepril) and observation group(Sacubitril/valsartan), with 43 cases in each group. At 3 months after operation, echocardiographic data［left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume(LVEDV), left ventricular ejection fraction(LVEF), stroke volume(SV)］, serum inflammatory factors［high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6)］, N-terminal pro-B-type natriuretic peptide(NT-proBNP), 6-min walking test, adverse reactions, prognosis and outcome were compared.Results After treatment, LVESV and LVEDD in the two groups were lower than those before treatment, and LVEF and SV were higher than those before treatment. However, LVESV and LVEDD in the observation group were lower than those in the control group, and LVEF and SV were higher than those in the control group, with statistically significant differences(P＜0.05). The levels of hs-CRP, IL-6 and NT-proBNP in the two groups were lower than those before treatment, which were lower in the observation group than in the control group, with statistically significant differences(P＜0.05). There was no statistically significant difference in the incidence of adverse reactions, such as hypotension, hyperkalemia and renal insufficiency between the two groups(P＞0.05). There was no statistically significant difference in recurrent myocardial infarction, ventricular tachycardia/frequent ventricular premature beats and sudden cardiac death between two groups(P＞0.05). The re-hospitalization rate of patients with heart failure in the observation group was lower than that in the control group, and the 6-min walking test in the observation group was longer than that in the control group, with statistically significant differences(P＜0.05).Conclusion Compared with benazepril, Sacubitril/valsartan can improve left ventricular function and left ventricular remodeling in patients with heart failure after myocardial infarction, increase its activity tolerance, and reduce the rate of re-hospitalization for heart failure, but will not increase the incidence of adverse reactions and adverse cardiovascular events.