张亚敏, 程爱媛, 林琦, 李迎, 刘建正, 王芳, 张亮, 袁铭, 王琼, 王婧, 杨华, 贺媛. 慢性心衰合并低血压患者沙库巴曲缬沙坦联合运动疗法改善心功能的疗效及安全性[J]. 心脏杂志, 2023, 35(1): 42-47. DOI: 10.12125/j.chj.202202054
    引用本文: 张亚敏, 程爱媛, 林琦, 李迎, 刘建正, 王芳, 张亮, 袁铭, 王琼, 王婧, 杨华, 贺媛. 慢性心衰合并低血压患者沙库巴曲缬沙坦联合运动疗法改善心功能的疗效及安全性[J]. 心脏杂志, 2023, 35(1): 42-47. DOI: 10.12125/j.chj.202202054
    shu
    Ya-min ZHANG, Ai-yuan CHENG, Qi LIN, Ying LI, Jian-zheng LIU, Fang WANG, Liang ZHANG, Ming YUAN, Qiong WANG, Jing WANG, Hua YANG, Yuan HE. Efficacy and safety of Sacubitril/valsartan combined with exercise therapy to improve cardiac functions in patients with chronic heart failure complicated with reduced ejection fraction and hypotension[J]. Chinese Heart Journal, 2023, 35(1): 42-47. DOI: 10.12125/j.chj.202202054
    Citation: Ya-min ZHANG, Ai-yuan CHENG, Qi LIN, Ying LI, Jian-zheng LIU, Fang WANG, Liang ZHANG, Ming YUAN, Qiong WANG, Jing WANG, Hua YANG, Yuan HE. Efficacy and safety of Sacubitril/valsartan combined with exercise therapy to improve cardiac functions in patients with chronic heart failure complicated with reduced ejection fraction and hypotension[J]. Chinese Heart Journal, 2023, 35(1): 42-47. DOI: 10.12125/j.chj.202202054
    shu

    慢性心衰合并低血压患者沙库巴曲缬沙坦联合运动疗法改善心功能的疗效及安全性

    Efficacy and safety of Sacubitril/valsartan combined with exercise therapy to improve cardiac functions in patients with chronic heart failure complicated with reduced ejection fraction and hypotension

      摘要
    • 摘要:
        目的  探讨合并低血压的射血分数降低的慢性心力衰竭患者在沙库巴曲缬沙坦药物治疗的基础上联合运动疗法改善心功能的疗效观察。
        方法  选取60例门诊治疗的心衰症状缓解的慢性心衰患者，血压90/50 mmHg～100/60 mmHg，左室射血分数（LVEF）≤40%，分为运动疗法组：沙库巴曲缬沙坦+运动疗法，对照组：单纯沙库巴曲缬沙坦组。两组患者在原发病治疗的基础上，根据血压情况逐渐滴定沙库巴曲缬沙坦致最大耐受剂量，运动疗法组加用运动训练。
        结果  与本组治疗前比较，对照组与运动疗法组治疗3个月后6-MWT数值增加，治疗6个月后数值增加量更多（均P<0.01）；与本组治疗前比较，对照组收缩压无统计学差异性变化，运动疗法组治疗3个月后收缩压数值增加，治疗6个月后数值增加量更多，（均P<0.01）；与本组治疗前比较，对照组舒张压治疗6个月后数值增加（P<0.01），运动疗法组舒张压治疗6个月后数值增加（P<0.01）。与本组治疗3个月后比较，对照组与运动疗法组治疗6个月后6-MWT数值增加（均P<0.01）。与对照组同时间点比较，运动疗法组治疗3个月后6-MWT与收缩压数值增加，治疗6个月后数值增加量更多（均P<0.01）；与本组治疗前相比，对照组与运动疗法组治疗3个月后LVEF增加，治疗6个月后增加更多，治疗3个月后LVESD、LVEDD、LVESV、LVEDV下降，治疗6个月后下降更多（均P<0.01）。与本组治疗3个月后相比，对照组与运动疗法组治疗6个月后LVEF增加，治疗6个月后LVESD、LVEDD、LVESV、LVEDV下降（均P<0.01）。运动疗法组与对照组同时间段比较， 运动疗法组治疗3个月后LVEF增加，治疗6个月后LVEF增加更多，治疗3个月后LVESD、LVEDD、LVESV、LVEDV下降，治疗6个月下降更多（均P<0.01）。运动疗法组再住院率低于对照组（P<0.05）。
        结论  合并有低血压的射血分数降低的慢性心衰患者，沙库巴曲缬沙坦加用运动疗法后，患者心功能改善明显且安全。

       

      Abstract:
        AIM   To investigate the efficacy and safety of Sacubitril/valsartan combined with exercise therapy on improvement of cardiac functions in patients with chronic heart failure complicated with hypotension and reduced ejection fraction.
        METHODS  Sixty chronic heart failure patients with controlled symptoms, blood pressure ranging from 90/50mmHg to 100/60mmHg and LVEF<40% were selected and they were divided into exercise therapy group (Sacubitril/valsartan + exercise) and control group (Sacubitril/valsartan alone). On the basis of their previous treatment, Sacubitril/valsartan was gradually prescribed to the maximum tolerated dose for the patients in the two groups according to their blood pressure, and exercise therapy was added in exercise group.
        RESULTS  Compared with the control group after 3 months of treatment, the amount of exercise in this group increased more than that in the control group after 3 months of treatment (P<0.01); Compared with that before treatment, there was no significant difference in systolic blood pressure in the control group. The value of systolic blood pressure in the exercise therapy group increased after 3 months of treatment and more after 6 months of treatment (all P<0.01); Compared with that before treatment, the diastolic blood pressure in the control group increased after 6 months of treatment (P<0.05), and the diastolic blood pressure in the exercise therapy group increased after 6 months of treatment (P<0.01). Compared with this group after 3 months of treatment, the value of 6-MWT in the control group and exercise therapy group increased after 6 months of treatment, all P<0.01. Compared with the control group at the same time point, the values of 6-MWT and systolic blood pressure in the exercise therapy group increased after 3 months of treatment, and increased more after 6 months of treatment (all P<0.01); Compared with that before treatment, LVEF in the control group and exercise therapy group increased after 3 months of treatment, increased more after 6 months of treatment, LVESD, LVESV and LVEDV decreased after 3 months of treatment, and decreased more after 6 months of treatment (all P<0.01). Compared with this group after 3 months of treatment, LVEF in the control group and exercise therapy group increased after 6 months of treatment, and LVESD, LVESD, LVESV and LVEDV decreased after 6 months of treatment (all P<0.01). Compared with the control group in the same time period, LVEF in the exercise therapy group increased after 3 months of treatment, increased more after 6 months of treatment, decreased LVESD, LVESD, LVESV and LVEDV after 3 months of treatment, and decreased more after 6 months of treatment (all P<0.01). The rehospitalization rate in the exercise therapy group was lower than that in the control group (P<0.05).
        CONCLUSION   In patients with heart failure complicated with hypotension and reduced ejection fraction, Sacubitril/valsartan plus exercise therapy is safe and markedly improves patients’ cardiac functions.

       

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