摘要
目的:观察托伐普坦对伴有低钠血症的顽固性心力衰竭患者临床症状、心功能改善情况及血钠水平的影响。方法:选择2014-01至2015-10于我院心内科住院的伴有低钠血症的顽固性心力衰竭患者100例,随机分为托伐普坦组和对照组,各50例,两组患者均给予常规强心、利尿、纠正离子紊乱治疗。托伐普坦组在常规治疗基础上加用托伐普坦15 mg/d,观察两组患者临床症状改善情况,心肾功能指标、离子水平的变化。结果:(1)托伐普坦组较对照组患者呼吸困难程度得到明显改善(P<0.01),肺部湿性啰音减少(P<0.05),双下肢水肿明显减轻(P<0.01)。托伐普坦组较对照组患者24 h尿量显著增加(ml,2 416.0±771.6 vs 1 124.6±215.7,P<0.01)N末端B型利钠肽原(NT-pro BNP)水平显著下降(pg/ml,2 678.04±537.09 vs 4 051.34±306.07,P<0.01);血钠水平显著升高(mmol/L,139.08±6.18 vs 129.44±2.20,P<0.01),差异均有统计学意义。(2)托伐普坦组有38例患者上述观察指标改善明显,用药1天后与用药前相比,血尿素氮水平即开始明显下降(mmol/L,7.28±1.53 vs 10.39±1.23,P<0.01);另外12例患者上述观察指标改善不明显,用药1天后与用药前比较,血尿素氮水平即开始显著升高(mmol/L,13.38±0.66 vs 10.39±1.23,P<0.01)。结论:托伐普坦能有效改善顽固性心力衰竭患者的临床症状、心功能状态,有助于提高血钠水平;可以通过早期尿素氮水平的变化评价托伐普坦的治疗效果。
Objective： To observe the effect of tolvaptan on treating the patients with intractable heart failure（HF） combining hyponatremia for their clinical conditions and improvements.Methods： A total of 100 relevant patients treated in our hospital from 2014-01 to 2015-01 were studied. Based on conventional treatment as cardiac stimulant,dieresis and correction of electrolyte disturbance,the patients were randomly divided into 2 groups： Tolvaptan group,the patients received tolvaptan15 mg/d for 5 days and Control group,the patients had no tolvaptan administration. n=50 in each group. The improvement of clinical symptoms,changes of cardiac,renal functions and blood levels of electrolyte were compared between 2 groups after treatment.Results：①Compared with Control group,Tolvaptan group had significantly improved dyspnea,reduced lung moist rale and low limb edema P0.01; Tolvaptan group showed increased 24 h urine volume（2416.0±771.6 vs 1124.6±215.7） ml,P0.01,decreased plasma levels of NT-proB NP（2678.04 ± 537.09） pg/ml vs（4051.34 ± 306.07） pg/ml,P0.01 and increased blood levels of sodium（139.08 ± 6.18） mmol/L vs（129.44 ± 2.20） mmol/L,P0.01.②In Tolvaptan group,the above improvements were found in 38 patients,and with 1 day tolvaptan therapy,their blood nitrogen dropped from（10.39 ± 1.23） mmol/L to（7.28 ± 1.53） mmol/L,P0.01; the other 12 patients had no such effect,and with 1 day tolvaptan therapy,their blood nitrogen elevated from（10.39±1.23） mmol/L to（13.38 ± 0.66） mmol/L,P0.01.Conclusion： Tolvaptan could effectively improve clinical symptom and cardiac function in patients with intractable HF,it is helpful to increase blood sodium level; the efficacy of tolvaptan might be evaluated by the changes of blood nitrogen at the early stage of treatment.
出处
《中国循环杂志》
CSCD
北大核心
2016年第4期341-344,共4页
Chinese Circulation Journal
