托伐普坦治疗合并低钠血症及利尿剂抵抗的心力衰竭  

Tolvaptan for treatment of decompensated heart failure patients with diuretic resistance and hyponatremia

作　　者：杨靖[1] 任雨笙[1] 厉娜[1] 梁春[1] 吴宗贵[1] 

机构地区：[1]第二军医大学长征医院心血管内科,上海200003

出　　处：《第二军医大学学报》2015年第10期1133-1137,共5页Academic Journal of Second Military Medical University

摘　　要：目的 评估短期小剂量托伐普坦治疗失代偿心力衰竭合并低钠血症的有效性和安全性。方法 筛选并回顾性分析2012年4月至2014年3月符合入选标准的患者资料,将患者分为托伐普坦组（15mg/d×7d）和标准治疗组（3%~4%高渗盐水×7d）。观察住院期间心力衰竭症状的改善和血清钠水平的升高情况以及口干、肌酐升高、神经系统症状等不良反应,统计出院后180d的心血管死亡率。结果 共有37例患者入选,其中托伐普坦组16例,标准治疗组21例。两组的基线资料差异无统计学意义。在规范化治疗基础上,托伐普坦组治疗第7天血清钠升高程度、出院前体质量减轻幅度、血浆N末端脑钠肽前体（NT-proBNP）水平降低幅度、心功能恢复到Ⅱ级（NYHA分级）以上的比率均大于标准治疗组（P〈0.05）,住院期间日均呋塞米用量、肌酐升高幅度以及住院天数均小于标准治疗组（P〈0.05）,但两组180d心血管死亡率差异无统计学意义（P〉0.05）。结论 对于利尿剂抵抗的失代偿心力衰竭合并低钠血症的患者,短期小剂量托伐普坦可改善短期内失代偿性心力衰竭的症状,升高血清钠浓度,减轻利尿剂抵抗,并且不良反应较少、耐受性良好,但并不降低长期心血管死亡率。Objective To assess the efficacy and safety of low dose short-term tolvaptan in treatment of decompensated heart failure patients with diuretic resistance and hyponatremia.Methods The clinical data of consecutive patients with decompensated heart failure,who were admitted to Changzheng Hospital from April 2012 to March 2014,were analyzed retrospectively.Patients were assigned to receiving tolvaptan（15 mg/d×7 d）or standard therapy（including 3%-4%hypertonic saline× 7 d）.The efficacy endpoints were heart failure symptoms relief,serum sodium elevation during hospitalization and cardiovascular death at 180 dfrom discharge.The safety endpoint included adverse effect of thirsty,renal function impairment and symptoms of nervous system.Results A total of 37 patients met the inclusion criteria and were assigned to tolvaptan（n=16）or standard therapy（n=21）.There were no significant differences between the 2groups at baseline.The elevation of serum sodium at day 7,reduction of body weight and NT-proBNP level before discharge,and the ratio of restoration to higher than NYHA classⅡin the tolvaptan group were all significantly more than those in the standard therapy group（P〈0.05）.Tolvaptan,compared with standard therapy,significantly decreased the mean dose of furosemide,serum creatinine elevation and hospital stay（P〈0.05）,but failed to lower the cardiovascular mortality at 180dfollow-up.Conclusion For Chinese patients with decompensated heart failure with diuretic resistance and hyponatremia,in addition to guideline-recommended therapies for heart failure,low dose short term tolvaptan is associated with more favorable in-hospital effects and less severe adverse effects,but not with long-term cardiovascular mortality.

关 键 词：托伐普坦 心力衰竭 低钠血症 利尿剂抵抗 

分 类 号：R541.6[医药卫生—心血管疾病]