托伐普坦治疗心衰合并低钠血症患者临床疗效观察  

Clinical effect of tolvaptan in patients with heart failure combined with hyponatremia

作　　者：高阳[1] 于海波[1] 梁延春[1] 焉晓蕾 许国卿[1] 武敏 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2017年第8期796-798,共3页Clinical Journal of Medical Officers

基　　金：辽宁省科学技术计划面上项目(2015020418);辽宁省科学技术计划面上项目(2015020406)

摘　　要：目的观察托伐普坦治疗慢性心力衰竭合并低钠血症患者的近期疗效及安全性。方法回顾性分析沈阳军区总医院心血管内科自2015年1月至2017年6月收治的58例心力衰竭合并低钠血症患者的临床资料。所有患者在指南推荐的规范抗心力衰竭药物治疗的基础上,口服托伐普坦7.5~15.0 mg/d,血钠升至正常范围停用。评估服药前后患者血钠、血肌酐、血钾及尿量的变化情况,并观察服药后的不良反应发生情况。所有入选患者根据血钠浓度分为3组,分别为重度低钠组(n=11)、中度低钠组(n=13)及轻度低钠组(n=34),比较3组患者用药后的血钠改善情况。结果本组患者应用托伐普坦治疗后的平均血钠水平为(138.4±3.4)mmol/L,高于用药前的(128.5±5.5)mmol/L;用药后平均尿量为(3 548.3±980.7)ml,显著高于治疗前的(1 295.0±796.3)ml,治疗前后比较,差异均有统计学意义(P<0.05)。治疗前后,血肌酐、血钾水平比较,差异无统计学意义(P>0.05)。低钠血症3个亚组患者用药后血钠水平均有显著提升。治疗期间有1例患者出现高钠血症,无高血钾、肝损害,无急性肾功能不全及原有肾功能加重。结论托伐普坦能够有效纠治心力衰竭患者的低钠血症,明显增加尿量,近期疗效显著,应用安全。Objective To investigate the short-term efficacy and safety of tolvaptan therapy for patients with chronic heart failure （CHF）combined with hyponatremia. Methods A retrospective study was performed on 58 cases of patients with heart failure combined with hyponatremia who were admitted from January 2015 to June 2017. The guidelines recommended for standardized anti-heart failure drugs were accepted by patients, and tolvaptan （7.5 to 15.0 mg/day）was added until the serum sodium returned to normal range. The changes of serum sodium, creatinine, potassium and urine volume before and after taking the medicine, and the adverse events after taking medicine were observed. According to the concentration of serum sodium, the patients were divided into 3 groups ： the severe hyponatremia group （ n = 11 ） , moderate hyponatremia group （ n = 13 ） and mild hyponatremia group （ n = 34 ）. The improvements were compared among the three groups after patients taking the medicine. Results The serum sodium mean level after tolvaptan treatment was significantly higher than that before the treatment, （ 138.4 ± 3.4 ） mmol/L versus （ 128.5 ± 5.5 ） mmol/L; the urine volume was increased after treatment, （ 3 548.3 ± 980. 7 ） ml versus （ 1 295.0 ± 796. 3 ） ml, （ P 〈 0. 05 ）. The creatinine and potassium had no statistically significant difference before and after the treatment （ P 〉 0. 05 ）. The serum sodium levels of the three subgroups of hyponatrcmia patients improved significantly after treatment. During the treatment, except one case of hyperuatremia, there was no hyperkalemia,liver damage, acute renal failure or deterioration of renal function happened during the treatment. Conclusion Tolvaptan can effectively correct hyponatremia and increase urine volume in treatment of patients with heart failure, which is effective and safe in short-term application.

关 键 词：慢性心力衰竭 低钠血症 托伐普坦 

分 类 号：R541[医药卫生—心血管疾病]