目的：探讨沙库巴曲缬沙坦钠对慢性心力衰竭（CHF）患者心电稳定性及心脏负荷的改善作用。方法：病例纳入2023年10月~2025年5月收治的102例CHF患者为研究对象，依据就诊时间段及治疗方案不同，将2023年3月~2024年6月沿用缬沙坦+螺内酯+比索洛尔治疗的51例患者列为常规组，将2024年7月~2025年9月采用沙库巴曲缬沙坦+螺内酯+比索洛尔治疗的51例患者列为试验组，比较两组患者的心肌纤维化，心电稳定性，心脏负荷及治疗安全性。所有患者均接受为期半年随访，比较两组患者的预后情况。结果：治疗后，试验组的基质金属蛋白酶-2（MMP-2）、基质金属蛋白酶-9（MMP-9）、半乳糖凝集素-3（Gal-3）、可溶性生长刺激表达基因2蛋白（sST2）均低于常规组（t=5.045，2.889，4.115，4.582；P＜0.05）。试验组的校正QT间期（QTc）、QT离散度（QTd）、T波峰-末间期（Tp-e）、室性早搏次数分别为（405.39±40.26）ms、（45.25±5.33）ms、（90.33±5.28）ms、（80.36±5.39）次/24h，均低于常规组[（450.22±42.19）ms、（50.37±6.15）ms、（95.29±6.44）ms、（85.27±6.18）次/24h]（t=5.490，4.493，4.253，4.276；P＜0.05）。试验组的收缩期肺动脉压（sPAP）、三尖瓣反流峰值速度（TRVmax）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）分别为（20.48±5.26）mmHg、（2.13±0.25）m/s、（45.29±5.62）mm、（30.61±5.33）mm，均低于常规组[（25.35±6.29）mmHg、（3.22±0.47）m/s、（50.45±6.15）mm、（35.49±6.27）mm]（t=4.242，14.622，4.423，4.235；P＜0.05）。试验组的药物相关副反应发生率与常规组比较，差异无统计学意义（P＞0.05）。截至随访结束时，试验组的不良预后发生率9.80%（5/51）低于常规组27.45%（14/51）（x2=5.239；P＜0.05）。结论：沙库巴曲缬沙坦钠能延缓CHF患者的心肌纤维化进程并改善心电稳定性，在有效改善心电稳定性并降低不良预后发生风险同时未显著增加治疗风险。
Objective:To explore the improvement effect of sacubitril valsartan sodium on electrocardiogram stability and cardiac load in patients with CHF.Methods:A total of 102 CHF patients admitted from October 2023 to May 2025 were included in the study. Based on the treatment period and regimen, 51 patients treated with valsartan, spironolactone, and bisoprolol from March 2023 to June 2024 were classified as the conventional group, while 51 patients treated with sacubitril/valsartan, spironolactone, and bisoprolol from July 2024 to September 2025 were designated as the experimental group. The myocardial fibrosis, electrocardiographic stability, cardiac workload, and treatment safety were compared between the two groups. All patients underwent a six-month follow-up to assess their prognosis.Results:After treatment, the levels of MMP-2, MMP-9, Gal-3, and sST2 in the experimental group were lower than the control group (t=5.045，2.889，4.115，4.582; P<0.05). The QTc, QTd, Tp-e, and number of ventricular premature beats in the experimental group were (405.39 ± 40.26) ms, (45.25 ± 5.33) ms, (90.33 ± 5.28) ms, and (80.36 ± 5.39) beats per 24 hours, lower than the control group [(450.22 ± 42.19) ms, (50.37 ± 6.15) ms, (95.29 ± 6.44) ms, and (85.27 ± 6.18) beats per 24 hours] (t=5.490，4.493，4.253，4.276; P<0.05). The sPAP, TRVmax, LVEDD, and LVESD of the experimental group were (20.48 ± 5.26) mmHg, (2.13 ± 0.25) m/s, (45.29 ± 5.62) mm, and (30.61 ± 5.33) mm, lower than the conventional group [(25.35 ± 6.29) mmHg, (3.22 ± 0.47) m/s, (50.45 ± 6.15) mm, and (35.49 ± 6.27) mm] (t=4.242，14.622，4.423，4.235; P<0.05). The incidence of drug-related side effects in the experimental group was not significantly different from that in the control group (P>0.05). As of the end of follow-up, the incidence of poor prognosis in the experimental group was 9.80% (5/51) lower than that in the conventional group 27.45% (14/51) (x2=5.239; P<0.05).Conclusion:Sacubitril valsartan sodium can delay the progression of myocardial fibrosis and improve electrocardiogram stability in CHF patients, effectively improving electrocardiogram stability and reducing the risk of adverse prognosis without significantly increasing treatment risk.
