目的 探究沙库巴曲缬沙坦治疗慢性心功能不全的疗效。方法 选取2018年11月—2019年12月河北北方学院附属第一医院治疗的84例慢性心功能不全患者作为研究对象，根据治疗方法将患者分为对照组和观察组，每组各42例。对照组采用常规药物治疗。观察组在对照组治疗基础上口服沙库巴曲缬沙坦钠片，患者在停止服用ACEI类药物2 d后，口服沙库巴曲缬沙坦钠片，初始剂量为50 mg/次，2次/d，后根据患者病情变化及药物耐受情况，逐渐增加剂量至200 mg/次，持续治疗3个月。观察两组的临床疗效，比较治疗前后两组患者心功能指标［左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）］和血清学指标［血清N末端B型钠尿肽前体（NT-proBNP）、基质金属蛋白酶-9（MMP-9）和可溶性生长刺激表达基因2蛋白（sST2）］的水平变化，以及堪萨斯城心肌病患者生活质量量表（KCCQ）评分情况。结果 治疗后，观察组总有效率为88.10%，显著高于对照组总有效率的66.67%，两组间比较差异具有统计学意义（P<0.05）。治疗后，两组患者LVEDD、LVESD均比治疗前降低，LVEF显著升高（P<0.05）；且治疗后观察组LVEDD、LVESD均明显低于对照组，LVEF明显高于对照组（P<0.05）。治疗后，两组患者NT-proBNP、MMP-9和sST2均显著降低（P<0.05）；且治疗后观察组NT-proBNP、MMP-9和sST2水平明显低于对照组（P<0.05）。治疗后，两组患者KCCQ评分均显著升高（PP<0.05）；且治疗后观察组KCCQ评分显著高于对照组（P<0.05）。结论 沙库巴曲缬沙坦治疗慢性心功能不全疗效好，可有效改善患者心功能，提高患者生活质量，具有临床推广价值。

Objective To investigate the efficacy of sacubitril valsartan in treatment of chronic cardiac insufficiency. Methods Eighty-four patients with chronic cardiac insufficiency treated in the First Affiliated Hospital of Hebei North University from November 2018 to December 2019 were selected as the research subjects. According to the treatment methods, the patients were randomly divided into control group and observation group, with 42 cases in each group. Patients in the control group was treated with conventional drugs. Patients in the observation group were po administered with Sacubitril Valsartan Sodium Tablets on the basis of control group, and the patients were given Sacubitril Valsartan Sodium Tablets with an initial dose of 50 mg/time, twice daily after stopping ACII drugs 2 days, and then the dose was gradually increased to 200 mg/time according to the changes in patients' condition and drug tolerance for 3 months. The clinical efficacy of two groups was observed. Cardiac function indexes (LVEF, LVEDD, LVESD), serological indexes (NT-proBNP, MMP-9, and sST2), and KCCQ scores were compared between two groups before and after treatment. Results After treatment, the total effective rate of the observation group was 88.10%, which was significantly higher than that of the control group (66.67%), and the difference between the two groups was statistically significant (P < 0.05). After treatment, LVEDD and LVESD in two groups were decreased compared with before treatment, while LVEF was significantly increased (P < 0.05). After treatment, LVEDD and LVESD in the observation group were significantly lower than those in the control group, and LVEF was significantly higher than those in the control group (P < 0.05). After treatment, NT-proBNP, MMP-9 and sST2 in two groups were significantly decreased (P < 0.05). After treatment, the levels of NT-proBNP, MMP-9 and SST2 in observation group were significantly lower than those in control group (P < 0.05). After treatment, KCCQ scores in two groups were significantly increased (P < 0.05). After treatment, the KCCQ score in observation group was significantly higher than that in control group (P < 0.05). Conclusions Sacubitril valsartan has good efficacy in treatment of chronic cardiac insufficiency, which can effectively improve the cardiac function of patients and improve the quality of life of patients, and has clinical promotion value.

R972

2020年度河北省医学科学研究课题计划（20200537）