小剂量托伐普坦联合呋塞米治疗急性心力衰竭合并利尿剂抵抗超高龄老年患者临床评价  

Efficacy and safety of low dose tolvaptan added to furosemide in very elderly patients with acute heart failure with diuretic resistance

作　　者：王伟[1] 边瓯[2] 马宁[2] 乔锐[2] 丁亮[2] 

机构地区：[1]广州军区总医院干部五病房,广东广州510010 [2]沈阳军区总医院干部病房一科,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第6期601-604,共4页Clinical Journal of Medical Officers

摘　　要：目的观察小剂量托伐普坦联合呋塞米在急性心力衰竭合并利尿剂抵抗超高龄老年患者中应用的疗效及安全性。方法选取自2013年1月至2015年6月在广州军区总医院干诊科住院的24例急性心力衰竭超高龄老年患者,平均年龄（94.16±7.03）岁。在维持长期治疗方案并强心、扩血管、改善肾灌注或（和）纠正低蛋白血症基础上,予呋塞米100~160 mg/d静脉泵注治疗5 d后,24 h尿量仍少于800 ml,在此治疗基础上加用托伐普坦7.5 mg/d口服7 d。观察记录患者每日的血压、心率、中心静脉压、尿量、心衰体征及不良事件。定期检查肝、肾功能,N末端B型脑钠肽前体（N-pro-BNP）及电解质,进行疗效及安全性评估。结果所有患者24 h尿量在治疗后48~72 h明显增加,治疗第3天尿量由（668.7±108.7）ml显著增加至（1 989.8±289.7）ml,差异有统计学意义（P〈0.01）。治疗结束时,心衰症状明显改善,中心静脉压由（18.9±2.3）cm H2O显著下降至（12.6±1.3）cm H2O,差异有统计学意义（P〈0.01）;N-pro-BNP由（13 385.3±7 545.9）pg/ml显著下降至（4 995.4±2156.2）pg/ml,差异有统计学意义（P〈0.01）;血肌酐由（171.8±57.5）μmol/L显著下降至（121.7±48.8）μmol/L,差异有统计学意义（P〈0.01）;所有患者均未发生高钠血症,无明显口渴;1例患者出现肝损害。结论小剂量托伐普坦联合呋塞米能够显著增加急性心力衰竭合并利尿剂抵抗超高龄老年患者的尿量,有效纠正心力衰竭症状,对其的救治具有临床意义。Objective To explore the efficacy and safety of low dose tolvaptan added to furosemide in very elderly patients with acute heart failure with diuretics-resistant. Methods A total of 24 patients with acute heart failure（ AHF） with volume overload resistant to loop diuretics[mean age（ 94. 16 ± 7. 03） years old] received in the General Hospital of Guangzhou Military Command from January2013 to June 2015. All the patients were given conventional treatment,in addition,tolvaptan was administered as a single oral dose of7. 5 mg once daily in the morning and furosemide was administered as an intravenous dose of 100 to 160 mg per day depending on the case for 7 days. The endpoints investigated were blood pressure,urinary output,central venous pressure,congestive symptoms,the function of liver and kidney,serum levels of N-pro-BNP,the serum sodium concentration and all adverse events were observed. Results24-hour urine volume of all patients increased significantly after treatment for 48-72 hours. The change in urine volume at third day from baseline was（ 668. 7 ± 108. 7） ml versus（ 1 989. 8 ± 289. 7） ml with statistical significance,（ P〈0. 01）. Congestive symptoms were significantly improved within 7 days. The central venous pressure was reduced remarkably（ 18. 9 ± 2. 3） cm H2 O versus（ 12. 6 ±1. 3） cm H2 O,（ P〈0. 01）. Blood levels of N-pro-BNP（ 13 385. 3 ± 7 545. 9） pg / ml versus（ 4 995. 4 ± 2 156. 2） pg / ml（ P〈0. 01）,and creatinine（ 171. 8 ± 57. 5） versus（ 121. 7 ± 48. 8） μmol / L（ P〈0. 01） were reduced significiantly. There were no hypernatremia or blunted thirst occurred except 1 case of liver impairment. Conclusion Adding a low dose of tolvaptan to furosemide could effectively increase urine volume,improve congestive symptoms of very elderly patients with AHF with volume overload and insufficient response to loop diuretics. This combination has good clinical value in such patients.

关 键 词：托伐普坦 心力衰竭 袢利尿剂 容量超负荷 超高龄 

分 类 号：R541.6[医药卫生—心血管疾病]