托伐普坦在高龄心力衰竭患者中的初步应用  

Preliminary application on tolvaptan use in elder patients with heart failure

作　　者：华参[1] 朱晓法[1] 马路[1] 王鸿燕[1] 卞宁[1] 任冰稳[1] 

机构地区：[1]海军总医院干部病房心血管内科,北京100048

出　　处：《转化医学杂志》2013年第3期146-149,共4页Translational Medicine Journal

基　　金：海军后勤部指令性课题(CHJ12L024)

摘　　要：目的观察托伐普坦在高龄心力衰竭患者中的安全性及疗效。方法对我科收治的15例高龄心力衰竭患者首日维持长期基础治疗方案,24 h后停用所有口服利尿药,予托拉塞米40 mg/d静脉推注、5 d,心力衰竭症状控制不满意换用托伐普坦15 mg/d口服、5 d;观察呼吸困难、肺部啰音、下肢水肿变化;监测体质量、血压,血钾、钠、氯、肌酐、尿素氮、尿酸、空腹血糖、低密度脂蛋白、三酰甘油、B型脑利钠肽,左室射血分数及24 h尿量、24 h尿钾/钠。结果相比托拉塞米,应用托伐普坦后呼吸困难、肺部啰音、下肢水肿改善明显,托伐普坦期24 h尿量增加[(2 455.60±720.68)ml与(2 047.93±439.08)ml比较,P<0.01],血清钠升高[(140.60±2.32)mmol/L与(133.80±7.79)mmol/L比较,P<0.01],尿钠排泄减少[(184.27±90.47)mmol与(267.33±90.14)mmol比较,P<0.01]。其余观察指标如体质量、血压及血钾、肌酐、尿酸、B型脑利钠肽等治疗前后差异均无统计学意义。结论在部分对利尿药反应不佳的高龄心力衰竭患者中,短期口服托伐普坦,能进一步改善症状和体征,且无严重不良反应。ObjectiveTo evaluate the efficacy and safety of tolvaptan in elder patiens with heart failure. MethodsFifteen elder patients were studied,they received initial conventional therapy in the first day, and later by a 5 day treatment period with torasemide（40 mg/d intravenous injection）,followed by a 5 day treatment period with tolvaptan （15 mg/d oral）. Dyspnea , pulmonary rales, lower limb edema were observed. Body weight, blood pressure, serum potassium, sodium, chlorine, creatinine, urea nitrogen, uric acid, blood fasting sugar, low density lipoprotein, triglyceride, BNP,left ventricular ejection fraction, 24 hour urine volume, urine sodium levels and potassium excretion were monitored. ResultsImprovement in dyspnea ,pulmonary rales, and lower limb edema were greater used tolvaptan than used torasemide. Increases in 24 hour urine volume was greater with tolvaptan than with torasemide [2 455.60±72068）ml vs. （2 047.93±43908） ml,P〈0.01].Increase in serum sodium with tolvaptan [14060±232） mmol/L vs. （13380±779） mmol/L ,P〈0.01） and decrease in urine sodium excretion [（18427±9047） mmol vs. （26733±9014） mmol,P〈0.01] were observed. No changes were in body weight, blood pressure, serum potassium, creatinine, uric acid, BNP and other laboratory items. ConclusionIn elder patients with heart failure, taking oral tolvaptan in addition to standard therapy including taking diuretics could improve many heart failure signs and symptoms, without serious adverse events.

关 键 词：心力衰竭 利尿药 血管加压素 老年人 

分 类 号：R541.61[医药卫生—心血管疾病] R983.1[医药卫生—内科学]