252例心力衰竭住院患者沙庫巴曲纈沙坦的用藥分析

孫瑩 顧永麗 孫增先

摘 要 目的：分析心力衰竭住院患者沙庫巴曲纈沙坦的用藥情況。方法：收集我院2019年10月-2020年3月使用沙庫巴曲纈沙坦的住院心力衰竭患者的資料，包括其基本信息，如性別、年齡、住院科室、住院時間等;匯總其沙庫巴曲纈沙坦使用情況（包括適應證、禁忌證、用法用量、用藥療程）、與血管緊張素轉化酶抑制劑（ACEI）/血管緊張素Ⅱ受體拮抗劑（ARB）類藥物的轉換、藥物不良反應等信息。結果：共收集到252例患者的資料，其中男性172例（68.25%）、女性80例（31.75%）;平均年齡為（67.02±14.23）歲，有85例（33.73%）的年齡≥75歲;平均住院時間為（12.03±8.19）d，用藥前平均左室射血分數（LVEF）為（38.69±10.45）%，平均血鉀水平為（4.16±0.65）mmol/L，平均腎小球濾過率估計值（eGFR）為（69.14±32.01）mL/（min·1.73 m2）。分布科室以心內科（59.14%）為主，其次為腎內科（8.73%）、呼吸科（7.14%）、心外科（5.95%）、老年科（5.56%）、急診內科（3.57%）和神經內科（3.17%）。所有患者均有用藥適應證，但有25例（9.92%）存在用藥禁忌證，其中6例（2.38%）為血鉀>5.4 mmol/L、19例（7.54%）為eGFR<15 mL/（min·1.73 m2）。用法用量以50 mg，bid為主（45.24%）;39例（15.47%）給藥頻次為qd，為不合理給藥;平均療程為（7.80±5.86）d。有7例患者（2.78%）與ACEI轉換，其中3例患者（42.86%）的轉換間隔時間未達36 h;20例患者（7.93%）與ARB轉換，均無明顯轉換不適宜情況。14例患者（5.56%）出現低血壓，其中2例經停藥、12例經減少用藥劑量后，血壓均恢復至正常范圍內;所有患者均未出現高血鉀、血管神經性水腫、腎功能損害、不自主肌肉顫動和心律失常等不良反應。結論：我院心力衰竭住院患者使用沙庫巴曲纈沙坦均有用藥適應證，且安全性良好，僅有少數患者出現血壓不耐受情況;但存在給藥劑量偏小、給藥頻次不適宜、禁忌證用藥、藥物轉換時機不適宜等情況。臨床藥師可開展合理用藥知識宣講，加強對患者的藥學監護，及時發現不合理用藥情況并監測不良反應，同時積極干預，以確保患者用藥的合理性及安全性。

關鍵詞 血管緊張素受體-腦啡肽酶抑制劑;沙庫巴曲纈沙坦;心力衰竭;住院患者;合理用藥;安全性

中圖分類號 R972+.9;R969.3 文獻標志碼 A 文章編號 1001-0408（2020）22-2801-05

DOI 10.6039/j.issn.1001-0408.2020.22.20

ABSTRACT? ?OBJECTIVE： To analyze the situation of inpatients with heart failure taking sacubitril-valsartan. METHODS： The data of heart failture inpatients using sacubitril-valsartan in our hospital were collected during Oct. 2019 to Mar. 2020， including basic information of patients such as gender， age， inpatient department， length of stay; the application of sacubitril-valsartan， including indications， contraindications， usage and dosage， course of medication; conversion with angiotensin converting enzyme inhibitor （ACEI）/angiotensin Ⅱ receptor antagonist （ARB） and adverse drug reactions， were summarized. RESULTS： A total of 252 cases were collected， including 172 males （68.25%） and 80 females （31.75%）. The average age of the patients was （67.02±14.23） years old， and 85 cases were 75 years or older （33.73%）. Average hospitalization time was （12.03±8.19）d， the average left ventricular ejection fraction （LVEF） before medication was （38.69±10.45）%， the average blood potassium was （4.16±0.65） mmol/L， and the average estimated value of glomerular filtration （eGFR） was （69.14±32.01） mL/（min·1.73 m2）. The main distri- bution departments were cardiology department （59.14%）， followed by nephrology department （8.73%）， respiration department （7.14%）， cardiac surgery department （5.95%）， geriatrics department （5.56%）， emergency medicine department （3.57%） and neurology department （3.17%）. All patients had indications， but 25 cases （9.92%） had contraindications， 6 cases （2.38%） had blood potassium>5.4 mmol/L， 19 cases （7.54%） had eGFR<15 mL/（min·1.73 m2）. The usage and dosage was 50 mg/bid （45.24%）; 39 cases （15.47%） were given medicine once a day， which was unreasonable. Average treatment course was（7.80±5.86） d. 7 patients （2.78%） converted to ACEI， and 3 patients （42.86%） had a conversion interval less than 36 h; 20 patients （7.93%） were converted to ARB， and there was no obvious inappropriate conversion. Hypotension occurred in 14 patients （5.56%）. Blood pressure returned to the normal range in 2 patients after drug withdrawal and 12 patients after dose reduction. No patient had adverse reactions such as hyperkalemia， angioneuro edema， renal impairment， involuntary muscle tremor and arrhythmia. CONCLUSIONS： All the inpatients with heart failure in our hospital have indications and good safety. Only a few patients have blood pressure intolerance. However， there were problems such as low dosage， inappropriate frequency of administration， drug use against contraindications， and inappropriate timing of drug conversion. Clinical pharmacists can carry out the knowledge propaganda of rational drug use， strengthen the pharmaceutical care of patients， timely detect the situation of irrational drug use and monitor adverse drug reactions， and actively intervene to ensure the rationality and safety of patients medication.

KEYWORDS? ?Angiotensin receptor-enkephalinase inhibitor; Sacubitril-valsartan; Heart failure; Inpatient; Rational drug use; Safety

心力衰竭是各種心血管疾病的終末階段，患者預后差且病死率高[1]。臨床常用由血管緊張素轉換酶抑制劑（ACEI）/血管緊張素Ⅱ受體拮抗劑（ARB）、醛固酮受體拮抗藥、β受體阻滯藥組成的“金三角”方案治療，但療效欠佳[2]。沙庫巴曲纈沙坦是全球首個血管緊張素受體-腦啡肽酶抑制劑（ARNI）。有研究證實，與依那普利相比，沙庫巴曲纈沙坦可使患者的主要復合終點（心血管死亡和心力衰竭住院）風險降低20%，全因病死率風險降低16%[3]。20……