Page 84 - 《中国药房》2021年23期

沙库巴曲缬沙坦钠对急性前壁心肌梗死合并急性心功能不全患

者短期预后的影响 Δ

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李锦爽 ，戚冉冉 ，王万虹 ，周 浩 ，陈春望 ，张荣林 （1.徐州医科大学附属宿迁医院/南京鼓楼医院集团宿迁
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医院心血管内科，江苏 宿迁 223800；2.南京大学医学院附属鼓楼医院心血管内科，南京 210008）
中图分类号 R541；R972 文献标志码 A 文章编号 1001-0408（2021）23-2890-05
DOI 10.6039/j.issn.1001-0408.2021.23.13
摘 要 目的：考察血管紧张素受体脑啡肽酶抑制剂（ARNI）沙库巴曲缬沙坦钠对急性前壁心肌梗死（AAMI）合并急性心功能不
全患者短期预后的影响。方法：将符合纳入标准的AAMI合并心功能Killip分级为Ⅱ～Ⅳ级的患者共80例，采用随机数字表法分
为ARNI组和对照组，各40例。两组患者均同时给予相同的基础规范化药物治疗、生命体征支持治疗以及经皮冠状动脉介入治疗
术治疗。在此基础上，ARNI组患者予以沙库巴曲缬沙坦钠片口服，起始剂量为25 mg/次，每日2次；此后逐渐调整剂量至200 mg/次，
每日2次。对照组患者予以马来酸依那普利片口服，起始剂量为5 mg/次，每日2次；此后逐渐调整剂量至10 mg/次，每日2次。两
组患者长期服药，在用药后1、3、6个月时至门诊随访。比较用药前后两组患者的N末端B型利钠肽原（NT-proBNP）、可溶性生长
刺激表达基因2蛋白（sST2）水平和超声心动图指标，记录用药后两组患者的6分钟步行试验（6MWT）数据和心源性再入院事件发
生情况。结果：与用药前比较，两组患者在用药后1、3、6个月时的各项指标均得到显著改善（P＜0.05）。与对照组比较，用药后3、
6个月时，ARNI组患者的NT-proBNP、sST2水平均显著降低（P＜0.05），左室射血分数和6MWT水平均显著提高（P＜0.05），左室
收缩末期内径和左室舒张末期内径均显著缩短（P＜0.05）；但两组患者的E峰与A峰流速比值、肺动脉压力、右室舒张末期内径和
心源性再入院事件发生率比较，差异均无统计学意义（P＞0.05）。结论：针对AAMI合并急性心功能不全患者，沙库巴曲缬沙坦钠
较依那普利能更为明显地改善患者的心功能（尤其是左心室收缩功能），减轻患者心肌细胞的炎症反应并保护心肌细胞，从而改善
患者的短期预后。
关键词 血管紧张素受体脑啡肽酶抑制剂；沙库巴曲缬沙坦钠；急性前壁心肌梗死；急性心功能不全；预后
Effects of Sacubitril Valsartan Sodium on Short-term Prognosis of Patients with Acute Anterior Myocardial
Infarction Complicated with Acute Cardiac Insufficiency
LI Jinshuang ，QI Ranran ，WANG Wanhong ，ZHOU Hao ，CHEN Chunwang ，ZHANG Ronglin（1. Dept. of
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Cardiology，Suqian Hospital Affiliated to Xuzhou Medical University/Suqian Hospital of Nanjing Drum Tower
Hospital Group，Jiangsu Suqian 223800，China；2. Dept. of Cardiology，Nanjing Drum Tower Hospital
Affiliated to Nanjing University Medical School，Nanjing 210008，China）
ABSTRACT OBJECTIVE：To investigate the effects of angiotensin receptor neprilysin inhibitor （ARNI） sacubitril valsartan
sodium（SVS）on the short-term prognosis of patients with acute anterior myocardial infarction（AAMI）complicated with acute
cardiac insufficiency. METHODS：A total of 80 patients with AAMI and Killip grade Ⅱ-Ⅳ of cardiac function，who met the
inclusion criteria，were randomly divided into ARNI group and control group，with 40 patients in each group. Both groups were
given the same basic standardized drug treatment，vital signs support treatment and percutaneous coronary intervention treatment at
the same time. On this basis，ARNI group was given SVS tablet orally，with initial dose of 25 mg each time，twice a day；
thereafter，gradually adjust the dose to 200 mg each time，twice a day. Control group was given Enalapril maleate tablets orally，
with an initial dose of 5 mg each time，twice a day；thereafter，gradually adjust the dose to 10 mg each time，twice a day. Both
groups took medicine for a long time，and were followed up after 1，3 and 6 months of medication to the clinic. The levels of
N-terminal pro-B-type natriuretic peptide （NT-proBNP）， soluble growth stimulation expressed gene 2 protein （sST2） and
echocardiography indexes were compared between 2 groups before and after medication. The 6-minute walking test（6MWT）and
the incidence of cardiogenic readmission events were recorded in 2 groups after medication. RESULTS：Compared with before
treatment，the indexes of the two groups were significantly improved at 1，3 and 6 months after treatment（P＜0.05）. Compared
with control group，the levels of NT-proBNP and sST2 in
Δ 基金项目：宿迁市科技项目（No.S201811）
ARNI group decreased significantly（P＜0.05），the levels of
＊副主任医师，博士。研究方向：冠心病介入诊疗技术、心血管急
left ventricular ejection fraction and 6MWT increased
危重症救治。E-mail：gd_l2000@163.com
# 通信作者：主任医师，教授，硕士生导师，博士。研究方向：冠心 significantly （P＜0.05），and the left ventricular end systolic
病基础与临床研究、介入诊疗技术。E-mail：doctorrlgl@126.com diameter and left ventricular end diastolic diameter decreased

·2890 · China Pharmacy 2021 Vol. 32 No. 23 中国药房 2021年第32卷第23期