Abstract: Objective　To investigate the effect of sacubitril/valsartan on chronic congestive heart failure in maintenance hemodialysis patients. Methods　A total of 60 patients with New York Heart Association (NYHA) cardiac function classification Ⅲ-Ⅳ who underwent maintenance blood purification in Affiliated Central Hospital of Shenyang Medical College from January 2020 to January 2021 were selected and were divided into a study group and a control group according to the random number table method, with 30 cases in each group. The study group included 21 males and 9 females, aged (63.5±11.9) years; the control group included 15 males and 15 females, aged (61.9±11.3) years. Both groups were assessed by the same physician to achieve　"dry weight". The study group was treated with sacubitril/valsartan on the basis of routine treatment, and the control group was treated with valsartan on the basis of routine treatment. Three months later, the changes of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), N-terminal pro-brain natriuretic peptide (NT-probNP), 6-min walking test distance (6MWT), serum creatinine (Scr), urea nitrogen (BUN), albumin, serum potassium, and blood pressure in the two groups before and after treatment were compared, and the cardiac function was assessed (all the above data were collected before dialysis). t test was used for the measurement data and χ² test or Fisher's exact probability method was used for the count data. Results　Before treatment, there were no statistically significant differences in the LVEF, LVEDD, NT-proBNP, 6MWT, Scr, BUN, albumin, serum potassium, and blood pressure between the two groups (all P>0.05). After treatment, the total effective rate of the study group was significantly higher than that of the control group [96.7% (29/30) vs. 73.3% (22/30)]; the LVEF, LVEDD, NT-proBNP, 6MWT, and blood pressure in both groups were better than those before treatment; compared with those in the control group, the LVEDD, NT-proBNP, and blood pressure in the study group were significantly reduced, while the LVEF and 6MWT were significantly increased; there were statistically significant differences between the two groups (all P<0.05). There were no significant changes in the Scr, BUN, albumin, and serum potassium between the two groups (all P>0.05). Conclusions　Sacubitril/valsartan can effectively improve chronic congestive heart failure in maintenance hemodialysis patients, and significantly reduce the arterial blood pressure, at the same time, there is no significant increase in serum potassium, and no significant change in Scr, BUN, or albumin.

Key words: Sacubitril/valsartan, Uremia, Hemodialysis, Chronic congestive heart failure

摘要： 目的　探究沙库巴曲缬沙坦对维持性血液透析患者慢性充血性心力衰竭的影响。方法　选取2020年1月至2021年1月在沈阳医学院附属中心医院行维持性血液净化，美国纽约心脏病协会（NYHA）心功能分级Ⅲ～Ⅳ级患者60例，按随机数字表法分为研究组和对照组各30例。研究组男21例，女9例，年龄（63.5±11.9）岁；对照组男15例，女15例，年龄（61.9±11.3）岁。两组患者均经同一医生评估达到干体重，研究组在常规治疗的基础上加用沙库巴曲缬沙坦，对照组在常规治疗的基础上加用缬沙坦。3个月后，比较两组患者治疗前后左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、N末端前体脑利钠肽（NT-proBNP）、6 min步行试验距离（6MWT）、血肌酐（Scr）、尿素氮（BUN）、白蛋白、血清钾和血压变化，并评估心功能（以上数据采集均在透析前进行）。计量资料采用t检验，计数资料采用χ²检验或Fisher确切概率法。结果　治疗前，两组LVEF、LVEDD、NT-proBNP、6MWT、Scr、BUN、白蛋白、血清钾和血压水平差异均无统计学意义（均P>0.05）。治疗后，研究组总有效率显著高于对照组［96.7%（29/30）比73.3%（22/30）］，两组LVEF、LVEDD、NT-proBNP、6MWT、血压均优于治疗前，且研究组相比于对照组LVEDD、NT-proBNP、血压显著降低，LVEF、6MWT显著增加，两组指标对比差异均有统计学意义（均P<0.05）。两组Scr、BUN、白蛋白、血清钾无明显改变，差异均无统计学意义（均P>0.05）。结论　沙库巴曲缬沙坦能有效改善维持性血液透析患者慢性充血性心力衰竭，显著降低动脉血压，血钾无明显升高，Scr、BUN、白蛋白无明显变化。

关键词: 沙库巴曲缬沙坦, 尿毒症, 血液透析, 慢性充血性心力衰竭