摘要
目的探讨沙库巴曲缬沙坦片治疗维持性肾脏替代治疗伴射血分数保留心力衰竭(HFpEF)的心功能改善情况及临床应用安全性。方法回顾性分析2019-01-01-2020-12-31泰安市中心医院肾病科门诊及病房68例维持性肾脏替代治疗伴射血分数保留心力衰竭患者,其中53例维持性血液透析伴HFpEF(血液透析组)、15例家庭式腹膜透析伴HFpEF(腹膜透析组),治疗8周。分别比较2种透析方式患者服用沙库巴曲缬沙坦片前后心功能改善总有效率、N末端前体B型钠尿肽(NT-pro BNP)水平、超声心动图指标、6 min步行试验(6MWT)及明尼苏达州心力衰竭生活质量评分(MLHFQ)、血钾、血肌酐水平等。结果2组患者治疗后心功能改善血液透析组53例患者,有效51例,总有效率达96.23%;腹膜透析组15例患者有效14例,总有效率达93.33%。血液透析组NT-pro BNP治疗后(4951.43±1964.37)pg/mL与治疗前(9811.50±1061.15)pg/mL比较,差异有统计学意义,P<0.001;6MWT治疗后(372.14±45.41)m与治疗前(335.28±32.62)m比较,差异有统计学意义,P<0.001;超声心动图指标LVEF治疗后(56.33±10.27)%与治疗前(51.14±8.71)%比较,差异有统计学意义,P=0.006;MLHFQ治疗后(43.20±8.15)分与治疗前(67.39±12.04)分比较,差异有统计学意义,P<0.001;腹膜透析组NT-pro BNP治疗后(5106.80±1968.79)pg/mL与治疗前(9611.11±1363.52)pg/mL比较,差异有统计学意义,P<0.001;6MWT治疗后(400.32±52.40)m与治疗前(330.82±31.39)m比较,差异有统计学意义,P<0.001;超声心动图指标LVEF治疗后(56.58±10.15)%与治疗前(50.32±8.84)%比较,差异有统计学意义,P=0.008;MLHFQ治疗后(37.32±8.26)分与治疗前(65.75±11.43)分比较,差异有统计学意义,P<0.001。血液透析组血钾治疗前(4.52±0.42)mmol/L与治疗后(4.65±0.45)mmol/L比较,差异无统计学意义,P>0.05;血肌酐治疗前(749.03±196.04)μmol/L与治疗后(798.54±180.93)μmol/L比较,差异无统计学意义,P>0.05。腹膜透析组血钾治疗前(4.73±0.44)mmol/L与治疗后(4.79±0.40)mmol/L比较,差异无统计学意义,P>0.05;血肌酐治疗前(825.55±180.75)μmol/L与治疗后(799.43±171.34)μmol/L比较,差异无统计学意义,P>0.05。结论沙库巴曲缬沙坦片可显著改善维持性血液透析或腹膜透析伴HFpEF患者的心功能,安全有效地提高患者生活质量。
Objective A retrospective analysis was conducted on the improvement of cardiac function and clinical safety of sakubatrel valsartan tablets in the treatment of maintenance renal replacement therapy with ejection fraction reserved heart failure(HFpEF).Methods Totally 68 patients with maintenance renal replacement therapy with HFpEF in the nephrology clinic and ward of Tai’an City Center Hospital from January 1,2019 to December 31,2020 were retrospectively analyzed,including 53 patients with maintenance hemodialysis with HFpEF(hemodialysis group)and 15 patients with family peritiopathic dialysis with HFpEF(peritiopathic dialysis group).Both groups were treated for 8 weeks and the total effective rate of improvement of cardiac function,NT-pro BNP level,echocardiographic index,6 MWT and MLHFQ before and after treatment between the two groups were compared.Results After treatment,53 patients in hemodialysis group had improved cardiac function,51 patients were effective,the total effective rate was 96.23%;In the peritoneal dialysis group,14 of 15 patients were effective,and the total effective rate was 93.33%.There was significant difference between(4951.43±1964.37)pg/ml after NT-Pro BNP treatment and(9811.50±1061.15)pg/ml before treatment in hemodialysis group(P<0.001);There was significant difference between(372.14±45.41)m after 6MWT treatment and(335.28±32.62)m before treatment(P<0.001);Echocardiographic index of LVEF after treatment was(56.33±10.27)%,compared with(51.14±8.71)%before treatment,the difference was statistically significant,P=0.006;The difference was statistically significant in the score of MLHKQ after treatment(43.20±8.15)and before treatment(67.39±12.04),P<0.001.There was significant difference between(5106.80±1968.79)pg/ml after NT Pro BNP treatment and(9611.11±1363.52)pg/ml before treatment in peritoneal dialysis group(P<0.001);There was significant difference between(400.32±52.40)m after 6MWT treatment and(330.82±31.39)m before treatment(P<0.001);Echocardiographic index of LVEF after treatment was(56.58±10.15)%,compared with that before treatment(50.32±8.84)%,the difference was statistically significant,P=0.008;The score of MLHFQ after treatment(37.32±8.26)was significantly lower than that before treatment(65.75±11.43)(P<0.001).There was no significant difference in blood potassium between(4.52±0.42)mmol/L before treatment and(4.65±0.45)mmol/L after treatment in hemodialysis group(P>0.05);There was no significant difference in serum creatinine(749.03±196.04)μmol/l before treatment and(798.54±180.93)μmol/l after treatment,P>0.05.In the peritoneal dialysis group,there was no significant difference in serum potassium before treatment(4.73±0.44)mmol/l and after treatment(4.79±0.40)mmol/l,P>0.05;There was no significant difference in serum creatinine(825.55±180.75)μmol/l before treatment and(799.43±171.34)μmol/l after treatment,P>0.05.Conclusion Sacrubitril/valsartan treating patients with end-stage renal disease combined with HFPEF can significantly improve the clinical symptoms,safely and effectively improve the patients’quality of life.
作者
王丽雅
张鹏
刘芬芬
吕学爱
WANG Li-ya;ZHANG Peng;Liu Fen-fen;LYU Xue-ai(Taian City Central Hospital,Taian 271000,China)
出处
《社区医学杂志》
CAS
2022年第10期552-556,共5页
Journal Of Community Medicine
关键词
沙库巴曲缬沙坦片
血液透析
腹膜透析
射血分数保留心力衰竭
sacubitril/valsartan
hemodialysis
peritoneal dialysis
heart failure with preserved ejection fraction
作者简介
第一作者:王丽雅,女,山东泰安人,硕士,副主任医师,主要从事终末期肾病替代治疗的研究工作。E-mail:Liya_dr@126.com;通信作者:张鹏,男,山东泰安人,硕士,副主任医师,主要从事椎间盘突出、骨质疏松和骨肿瘤的研究工作。E-mail:Zhangpeng80324@126.com
