托伐普坦治疗利尿剂抵抗心力衰竭患者的临床研究  

Clinical Study on Tolvaptan in the Treatment of Diuretic-resistant Heart Failure Patients

作　　者：刘刚[1] 毛敏[1] 张帆 黄玮[1] 雷寒[1] 杨渊[1] LIU Gang MAO Min ZHANG Fan HUANG Wei LEI Han YANG Yuan(Dept. of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China)

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400016 [2]重庆医科大学公共卫生与管理学院流行病学教研室,重庆400016

出　　处：《中国药房》2017年第29期4093-4095,共3页China Pharmacy

基　　金："十二五"国家科技支撑计划项目(No.2011BAI11B01)

摘　　要：目的:评估托伐普坦治疗利尿剂抵抗心力衰竭患者的临床效果及安全性。方法:回顾性分析2014年1月-2016年8月在重庆医科大学附属第一医院心血管内科病房住院的21例利尿剂抵抗心力衰竭患者的临床资料。所有患者在接受大剂量袢利尿剂(呋塞米和/或托拉塞米)治疗后,心力衰竭改善不明显;后改为托伐普坦治疗,其中19例患者口服托伐普坦片7.5 mg,qd,2例患者口服托伐普坦片15 mg,qd,均连续治疗直至出院。比较21例患者治疗前后的心功能、水肿程度、结局及体质量、血压、血钠、血肌酐、血N末端B型利钠肽原(NT-proBNP)水平和单位时间尿量的变化,并观察不良反应发生情况。结果:治疗后,21例患者心功能明显改善、水肿程度明显减轻、收缩压明显降低、血钠明显升高、单位时间尿量明显增多,与治疗前比较差异均有统计学意义(P<0.05);但治疗前后体质量、舒张压、血肌酐和血NT-proBNP水平比较,差异均无统计学意义(P>0.05)。21例患者中有1例出现口干,3例收缩压较基础值降低20 mm Hg及以上,4例舒张压较基础值降低10 mm Hg及以上。结论:对出现利尿剂抵抗的患者,托伐普坦能显著增加其尿量、改善心功能、纠正低钠血症,且对收缩压有降低作用。OBJECTIVE： To evaluate clinical effect and safety of tolvalptan in the treatment of diuretic-resistant heart failure. METHODS： The clinical data of 21 inpatients with diuretic-resistant heart failure in cardiology department of the First Affiliated Hospital of Chongqing Medical University during Jan. 2014-Aug. 2016 were analyzed retrospectively. The heart failure improvement of 21 patients was not obvious after the treatment of a large dose of loop diuretics （furosemide and/or torasemide）, and then the treatment was changed into tovalptan. Among them, 19 patients were treated with Tovalptan tablets 7.5 mg orally, qd, and 2 pa- tients were treated with Tovalptan tablets 15 mg orally, qd, continuously until the patients discharged. The cardiac function, ede- ma, outcome and body weight, blood pressure, blood sodium, blood creatinine and blood NT-proBNP levels, the change of urine volume per unit time were compared among 21 patients before and after treatment. The occurrence of ADR was observed. RE- SULTS： After treatment, cardiac function of 21 patients were improved significantly, edema and systolic blood pressure were de- creased significantly while blood sodium and urine volume per unit time were increased significantly, with statistical significance （P〈0.05）. There was no statistical significance in body weight, diastolic blood pressure, blood creatinine or blood NT-proBNP lev- els before and after treatment （P〉0.05）. Among 21 patients, one patient suffered from dry mouth; systolic blood pressure of 3 pa- tients decreased by 20 mmHg or above, compared to basic value; diastolic blood pressure of 4 patients decreased by 10 mmHg or above, compared to basic value. CONCLUSIONS： For diuretic-resistant patients, tolvaptan can increase urine volume, improve cardiac function and correct hyponatremia, besides it also lowers the systolic blood pressure.

关 键 词：托伐普坦 心力衰竭 利尿剂抵抗 

分 类 号：R541.6[医药卫生—心血管疾病]