目的 觀察沙庫巴曲纈沙坦鈉片治療難治性心力衰竭的臨床療效。方法 選取2018年10月—2019年10月在天津市第二醫(yī)院心內(nèi)科住院治療的共84例難治性心力衰竭患者為研究對象，入選患者按照隨機(jī)數(shù)字法分為對照組44例、治療組40例。對照組口服馬來酸依那普利片，起始劑量10 mg/次，2次/d，根據(jù)血壓情況增加到患者能承受的最大劑量。治療組口服沙庫巴曲纈沙坦鈉片，起始劑量25～50 mg/次，2次/d，根據(jù)血壓、患者耐受性逐漸加量，最大劑量400 mg/d。兩組患者連續(xù)治療6個(gè)月。觀察兩組的臨床療效，比較兩組的心功能指標(biāo)[左室射血分?jǐn)?shù)（LVEF）、左室舒張末期內(nèi)徑（LVEDD）和左心室后壁厚度（LVPW）]、血清因子[血漿N末端腦鈉肽前體（NT-proBNP）、血漿去甲腎上腺素（NE）、血管緊張素Ⅱ（AngⅡ）和醛固酮（ALD）]和明尼蘇達(dá)生活質(zhì)量評分（MLHFQ）。結(jié)果 治療后，對照組和治療組的臨床總有效率分別為88.63%、95.00%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。與治療前相比，兩組的LVEF均顯著增高，LVEDD、LVPW均顯著降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，治療組LVEF顯著高于對照組，LVEDD、LVPW顯著低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。與治療前相比，兩組血清NT-proBNP、NE、AngⅡ和ALD水平均顯著降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，治療組血清NT-proBNP、NE、AngⅡ、ALD水平均顯著低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。與治療前相比，對照組與治療組MLHFQ均顯著降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，治療組MLHFQ顯著低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 沙庫巴曲纈沙坦鈉片治療難治性心力衰竭可明顯改善患者的臨床癥狀，提高心功能，改善心室重塑，提高生活質(zhì)量，具有臨床推廣使用價(jià)值。

Objective To observe the clinical efficacy of Sacubitril Valsartan Sodium Tablets in treatment of refractory heart failure. Methods Patients (84 cases) with refractory heart failure in Tianjin 2th Hospital from October 2018 to October 2019 were randomly divided into the control group (44 cases) and the treatment group (40 cases). Patients in the control group were po administered with Enalapril Maleate Tablets, starting dosage 10 mg/time, twice daily, and according to blood pressure, increased to the maximum dose that the patient could bear. Patients in the treatment group were po administered with Sacubitril Valsartan Sodium Tablets, starting dosage 25 — 50 mg/time, twice daily, then according to blood pressure and patient tolerance, the dosage was gradually increased, with a maximum dose of 400 mg/d. Patients in two groups were treated for 6 months. After treatment, the clinical efficacies were evaluated, and cardiac function indexes (LVEF, LVEDD, and LVPW), serum factors (NT-proBNP, NE, AngⅡ, and ALD), and MLHFQ in two groups were compared. Results After treatment, the total clinical effective rate of the control and treatment group was 88.63% and 95.00%, respectively, and there was difference between two groups (P<0.05). After treatment, LVEF in the two groups were significantly increased, but LVEDD and LVPW were significantly decreased, with statistically significant differences (P<0.05). After treatment, LVEF in the treatment group was significantly higher than that in the control group, but LVEDD and LVPW in the treatment group were significantly lower than that in the control group, with statistically significant differences (P<0.05). After treatment, the serum levels of NT-proBNP, NE, Ang Ⅱ, and ALD of the two groups were significantly decreased, and the difference was statistically significant (P<0.05). After treatment, the serum levels of NT- proBNP, NE, Ang Ⅱ, and ALD of the treatment group were significantly lower than that of the control group, and the difference was statistically significant (P<0.05). After treatment, MLHFQ in two groups were significantly decreased, and the difference was statistically significant (P<0.05). After treatment, MLHFQ in the treatment group was significantly lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion Sacubitril Valsartan Sodium Tablets has clinical curative effect in treatment of refractory heart failure, can significantly improve the clinical symptoms and cardiac function, improve ventricular remodeling and improve the quality of life, which is worthy of clinical application.

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