ARNI联合EECP在PCI术后应用价值及对无创血流动力学指标再住院率的影响

doi:10.3969/j.issn.1006-6233.2024.07.024

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摘要 目的: 探讨血管紧张素受体脑啡肽酶抑制剂(ARNI)联合增强型体外反搏(EECP)在经皮冠状动脉介入(PCI)治疗术后价值以及对无创血流动力学指标、再住院率的影响。方法: 选取2022年10月至2024年3月于山东第一医科大学附属人民医院心血管内科就诊的急性前壁心肌梗死并成功行急诊PCI治疗术后患者100例为研究对象,随机分为试验组和对照组,每组50例,试验组采用ARNI联合EECP进行治疗,对照组采用血管紧张素转化酶抑制剂(ACEI)进行治疗,比较两组的心功能指标、生活质量量表(SF-36)以及血流动力学指标和再住院率。结果: 治疗前,两组患者的心功能指标以及血流动力学指均无统计学差异(P>0.05),治疗7周后,两组患者的LVEDV、LVESV、NT-proBNP、ET-1、心率、SBP、DBP以及RS、CMR均降低,LVEF、CO、CI以及LSI、LCI、AC、COM均升高,较治疗前比较,均有统计学差异(P<0.05),且试验组改变幅度大于对照组,两组上述指标比较有统计学差异(P<0.05);治疗后6个月随访,LVEDV、LVESV、NT-proBNP、ET-1、心率、SBP、DBP以及RS、CMR继续降低,LVEF、CO、CI以及LSI、LCI、AC、COM继续升高,但改变幅度变小,两组上述指标比较仍具有统计学差异(P<0.05);治疗前,两组患者的SF-36中的生理职能、生理功能、情感职能、日常活动、精神健康、总体健康、社会功能、躯体疼痛评分比较均无统计学差异(P>0.05),治疗7周后,上述评分均上升,较治疗前比较,均有统计学差异(P<0.05),且试验组改变幅度大于对照组,两组上述指标比较也有统计学差异(P<0.05);治疗后6个月随访,上述指标继续上升,但改变幅度变小,两组上述指标比较仍具有统计学差异(P<0.05);两组患者治疗后6个月总主要不良心血管事件导致再住院率两组比较具有统计学差异(χ²=9.502,P=0.002);再发心肌梗死、心绞痛发作导致再住院率比较,无统计学差异(χ²=0.340,P=0.560;χ²=2.152,P=0.142),心力衰竭导致再住院率比较,差异有统计学意义(χ²=6.353,P=0.012)。结论: ARNI联合EECP在PCI术后可以改善心功能以及患者健康状态,降低阻力,降低术后不良反应发生率,从而降低再住院率。

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	王方明
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	亓华新

关键词 ：冠状动脉介入, 沙库巴缬沙坦, 增强型体外反搏, 应用价值, 血流动力学, 再住院率

Abstract：Objective: To investigate the efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) combined with enhanced external counterpulsation (EECP) after percutaneous coronary intervention (PCI) and its impact on non-invasive hemodynamic parameters and readmission rate. Methods: One hundred patients with acute anterior myocardial infarction who successfully underwent emergency PCI treatment at the Department of Cardiology, Shandong First Affiliated Hospital of Shandong University from October 2022 to March 2024 were randomly divided into a trial group and a control group (50 patients each). The trial group received ARNI combined with EECP treatment, and the control group received angiotensin-converting enzyme inhibitor (ACEI) treatment. The two groups were compared in terms of cardiac function, quality of life scale (SF-36), hemodynamic parameters, and readmission rate. Results: Before treatment, there was no significant difference in cardiac function and hemodynamic parameters between the two groups (P>0.05). After 7 weeks of treatment, the levels of LVEDV, LVESV, NT-proBNP, ET-1, heart rate, SBP, DBP, RS, and CMR were decreased, while LVEF, CO, CI, LSI, LCI, AC, and COM were increased in both groups compared to before treatment (P<0.05). The magnitude of change was greater in the trial group than in the control group, and there was a significant difference between the two groups in these parameters (P<0.05). At 6-month follow-up, LVEDV, LVESV, NT-proBNP, ET-1, heart rate, SBP, DBP, RS, and CMR continued to decrease, while LVEF, CO, CI, LSI, LCI, AC, and COM continued to increase. However, the magnitude of change was smaller, and there was still a significant difference between the two groups in these parameters (P<0.05). Before treatment, there was no significant difference in the scores of physical function, physical function, emotional function, daily activities, mental health, overall health, social function, and physical pain on the SF-36 between the two groups (P>0.05). After 7 weeks of treatment, the scores of all of these items increased compared to before treatment (P<0.05), and the magnitude of change was greater in the trial group than in the control group. There was also a significant difference between the two groups in these items (P<0.05). At 6-month follow-up, the scores of these items continued to increase, but the magnitude of change was smaller. There was still a significant difference between the two groups in these items (P<0.05). The total major adverse cardiovascular event (MACE)-related readmission rate at 6 months after treatment was significantly different between the two groups (χ²=9.502, P=0.002). There was no significant difference in the readmission rate due to recurrent myocardial infarction or angina pectoris (χ²=0.340, P=0.560; χ²=2.152, P=0.142), but the readmission rate due to heart failure was significantly different (χ²=6.353, P=0.012). Conclusion: ARNI combined with EECP after PCI can improve cardiac function and patient health status, reduce resistance, reduce the incidence of adverse reactions after surgery, and thus reduce the readmission rate.

Key words： Percutaneous coronary intervention Sacubitril/valsartan Enhanced external counterpulsation Efficacy Hemodynamics Readmission rate

基金资助:山东省济南市卫生健康委员会科技计划项目,(编号:2022-2-53)

引用本文:

王方明, 王翔, 亓华新. ARNI联合EECP在PCI术后应用价值及对无创血流动力学指标再住院率的影响[J]. 河北医学, 2024, 30(7): 1185-1191.
WANG Fangming, WANG Xiang, QI Huaxin. Efficacy of Angiotensin Receptor-Neprilysin Inhibitor Combined with Enhanced External Counterpulsation After Percutaneous Coronary Intervention and Its Impact on Non-invasive Hemodynamic Parameters and Readmission Rate. HeBei Med, 2024, 30(7): 1185-1191.

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