Study On The Efficacy And Safety Of Sacubitril Valsartan In The Treatment Of Chronic Heart Failure Complicated With Renal Insufficiency

Objective: This article is designed in order to investigating the efficacy and safety of Sacubitril Valsartan in the treatment of chronic heart failure complicated with renal insufficiency.Method: A prospective clinical study was conducted to select 60 patients with heart failure complicated with renal insufficiency who were hospitalized in seventh department of Cardiovascular Division,Second Hospital of Hebei Medical University from January 2018 to June 2018.The patients were randomly divided into two groups: experimental group(30 cases in the Sacubitril Valsartan group)and matched group(30 cases in the Enalapril group).Both groups were given routine treatment of heart failure,including oxygen inhalation and cardiac stimulant,diuresis promotion,vasodilation,ventricular rate control,water and electrolyte acidbase balance.On this basis,the control group was given enalapril tablets,10 mg orally twice a day.After36 hours of ACEI,the treatment group was changed to Sacubitril Valsartan.The initial dose was 50 mg twice a day,and the dose was doubled every two weeks until the target dose was 200 mg twice a day or blood pressure was less than 90/60 mmHg.The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and N-terminal brain natriuretic peptide precursor(NT-proBNP)were measured at admission,3 months and 6months respectively.Meanwhile,serum beta 2-microglobulin(beta 2-MG),urea nitrogen(BUN),creatinine(SCr),glomerular filtration rate(eGFR),cystatin C(Cys-C)and other renal function indicators were collected.The two groups of patients before and after treatment and between groups were compared,and the changes of cardiac and renal function indexes before and after treatment were statistically analyzed.Result:1.Comparison of the general situation between treatment group and matched groupThere was no statistical significance between the two groups before treatment in the cause of heart failure,sex,age,complications and NYHA classification of heart failure and they were comparable(P > 0.05).2.Comparison of cardiac function indexes between treatment group and matched group before and after treatmentBefore treatment,there was no statistical significance in the levels of LVEF and LVEDD between the two groups(P > 0.05).At 3 months after treatment,there was no statistical significance in the levels of LVEF and LVEDD between the two groups compared with those before treatment(P >0.05),and there was no statistical significance between the two groups(P >0.05).At 6 months after treatment,the LVEF of the two groups increased significantly(P < 0.05)and the LVEDD decreased significantly(P < 0.05)compared with that before treatment,and the therapeutic effect of the treatment group was more significant than that of the matched group with statistical significance(P < 0.05).3.Comparison of NT-proBNP between treatment group and matched group before and after treatmentBefore treatment,there was no statistical significance in NT-proBNP between the treatmentl group and the matched group(P > 0.05).At 3 months after treatment,NT-proBNP in the two groups was significantly lower than that before treatment(P < 0.05),but there was no statistical significance between the two groups(P > 0.05).At 6 months after treatment,NT-proBNP in the two groups was significantly lower than that before treatment(P < 0.05),and the effect of the treatmentl group was more significant than that of the matched group(P < 0.05).4.Comparison of renal function indexes between treatment group and matehed group before and after treatmentBefore treatment,there was no significant difference in BUN,Scr,CysCand ?2MG levels between the treatment group and the matched group(P >0.05).At 3 months after treatment,BUN,Scr,CysC and ?2MG levels in the two groups were not significantly different from those before treatment(P >0.05),and there was no statistical significance between the two groups(P >0.05).At 6 months after treatment,the levels of BUN,Scr,CysC and ?2MG in the two groups were significantly lower than those before treatment with statistical significance(P < 0.05);at the same time,the levels of CysC and?2MG in the two groups were significantly different(P < 0.05);but there was no statistical significance in the levels of BUN and Scr between the two groups(P > 0.05).Conclusion:1.Shakubate Valsartan can effectively increase LVEF and reduce LVEDD,thereby improving cardiac function in patients with chronic heart failure and renal insufficiency,and theefficacy of Shakubate Valsartan is superior to enalapril hydeochloride.2.Shakubate Valsartan can effectively reduce the levels of BUN,Scr,UA,CysC and ?2MG in patients with chronic heart failure and renal insufficiency,and improve renal function.