2021 年第 7 期 第 16 卷

冠心病合并心力衰竭患者冠状动脉旁路移植术后应用沙库巴曲缬沙坦的疗效观察

Efficacy of sacubitril valsartan on patients with coronary atherosclerotic heart disease and heart failure after coronary artery bypass grafting

作者：方颖刘长城韦华宋伟吴震顾承雄

英文作者：Fang Ying Liu Changcheng Wei Hua Song Wei Wu Zhen Gu Chengxiong

单位：首都医科大学附属北京安贞医院心脏外科100029

英文单位：Department of Cardiovascular Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；心力衰竭；沙库巴曲缬沙坦；冠状动脉旁路移植术；N末端B型脑钠肽前体

英文关键词：Coronaryatheroscleroticheartdisease;Heartfailure;Sacubitrilvalsartan;Coronaryarterybypassgrafting;N-terminalpro-brainnatriureticpeptide

• 摘要：

• 目的 探讨冠状动脉旁路移植术（CABG）后应用沙库巴曲缬沙坦对冠心病（冠状动脉粥样硬化性心脏病）合并射血分数降低型心力衰竭（HFrEF）患者早期预后的影响。方法 选取2018年1月至2019年1月在首都医科大学附属北京安贞医院接受择期CABG的冠心病合并HFrEF患者92例，应用随机数字表法分为观察组（45例）和对照组（47例）。观察组患者CABG术后7 d给予沙库巴曲缬沙坦钠片口服治疗，对照组患者CABG术后7 d给予缬沙坦胶囊口服治疗，2组患者CABG术后均给予心力衰竭管理指南推荐的其他药物治疗，均连续用药12个月。比较2组药物治疗前后左心室射血分数（LVEF）、血浆N末端B型脑钠肽前体(NT-proBNP)、肾脏功能和血钾水平，以及治疗期间不良心血管事件和药物不良反应发生率。结果 药物治疗前，2组LVEF和血浆NT-proBNP水平比较差异均无统计学意义（均P＞0.05）；药物治疗12个月后，2组LVEF均高于治疗前、且观察组高于对照组［(47±4)%比（45±4）%］，血浆NT-proBNP水平均低于治疗前、且观察组低于对照组［(686±197)ng/L比（892±247）ng/L］（均P＜0.05）。2组药物治疗前后血肌酐、血尿素氮和血钾水平，以及治疗期间不良心血管事件、症状性低血压发生率比较差异均无统计学意义（均P＞0.05），且治疗期间均无因严重高钾血症、血管性水肿而停药的患者。结论 与缬沙坦比较，CABG术后早期应用沙库巴曲缬沙坦能显著降低冠心病合并HFrEF患者的NT-proBNP水平，改善心脏功能，且安全性良好。

• Objective To investigate the efficacy of sacubitril valsartan on the early prognosis of patients with coronary atherosclerotic heart disease (CHD) and heart failure with reduced ejection fraction (HFrEF) after coronary artery bypass grafting (CABG). Methods From January 2018 to January 2019, 92 patients with CHD and HFrEF who received elective CABG in Beijing Anzhen Hospital, Capital Medical University were selected and randomly divided into observation group (45 cases) and control group (47 cases). Patients in the observation group were treated with sacubitril valsartan sodium tablets orally 7 d after CABG; patients in the control group were treated with valsartan capsules orally 7 d after CABG; patients in both groups were treated with other drugs recommended by heart failure management guidelines after CABG, and they were treated for 12 months. The left ventricular ejection fraction (LVEF), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), renal function and serum potassium levels, as well as the incidences of adverse cardiovascular events and adverse drug reactions were compared between the two groups before and after treatment. Results Before drug treatment, there were no significant differences in LVEF and plasma NT-proBNP levels between the two groups (both P>0.05); after 12 months of drug treatment, LVEF of the two groups were higher than those before treatment, and that of the observation group was higher than that of the control group ［(47±4)% vs (45±4)%］; plasma NT-proBNP levels of the two groups were lower than those before treatment, and that of the observation group was lower than that of the control group ［(686±197)ng/L vs (892±247)ng/L］(all P<0.05). There were no significant differences in serum creatinine, blood urea nitrogen and serum potassium levels before and after treatmen, adverse cardiovascular events and symptomatic hypotension incidences between the two groups(all P>0.05). There were no patients with severe hyperkalemia and vascular edema during treatment. Conclusion Compared with valsartan, sacubitril valsartancan significantly reduces NT-proBNP levels and improves cardiac function with good safety in patients with CHD and HFrEF in early stage after CABG.