托伐普坦与托拉塞米治疗重症心力衰竭伴稀释性低钠血症的效果比较  

Comparison of the therapeutic effects of tolvaptan and torasemide in treatment of severe heart failure complicated by diluent hyponatremia

作　　者：王茜[1] 杨小东[1] 刘东霞[1] 赵海双 崔国旺 张征[2] WANG Qian;YANG Xiaodong;LIU Dongxia(The Second Central Hospital of Baoding City,Hebei,Baoding 071000,China)

机构地区：[1]河北省保定市第二中心医院,071000 [2]河北大学附属医院

出　　处：《河北医药》2018年第23期3582-3585,共4页Hebei Medical Journal

摘　　要：目的观察分析托伐普坦与托拉塞米治疗重症心力衰竭伴稀释性低钠血症的效果。方法选取2015年11月至2018年2月收治的136例重症心力衰竭伴稀释性低钠血症患者为观察对象。依据计算机随机分组法将所有患者分为2组,其中68例患者采用托拉塞米治疗,设为对照组;另68例患者采用托伐普坦治疗,设为试验组。比较2组患者心力衰竭疗效、稀释性低钠血症疗效,比较2组患者治疗前后实验室指标[左心室射血分数(LVEF)、脑钠肽(BNP)、24 h尿量]、血钠、血钾及血浆渗透压各指标的水平变化情况。结果 2组治疗效果比较,试验组心力衰竭总有效率为97. 06%、稀释性低钠血症总有效率为95. 59%,均高于对照组,差异有统计学意义(P <0. 05); 2组治疗前各实验室指标比较,差异无统计学意义(P> 0. 05); 2组治疗后LVEF、BNP、24 h尿量均较治疗前改善,其中试验组LVEF为(34. 56±4. 88)%,高于对照组; BNP为(1 130. 54±152. 62) ng/L,低于对照组; 24 h尿量为(2 156. 66±220. 57) ml,多于对照组,差异有统计学意义(P <0. 05); 2组治疗前血钠、血钾及血浆渗透压比较,差异无统计学意义(P> 0. 05);治疗后2组血钾水平比较,差异无统计学意义(P> 0. 05);试验组血钠与血浆渗透压均高于对照组,差异有统计学意义(P <0. 05)。结论相比较于托拉塞米,托伐普坦治疗重症心力衰竭伴稀释性低钠血症的疗效更佳,可改善心功能,减轻水肿症状,值得推荐应用。Objective To observe the therapeutic effects of tolvaptan and torasemide in treatment of severe heart failure complicated by diluent hyponatremia.Methods A total of 136 patients with severe heart failure complicated by diluent hyponatremia who were admitted and treated in our hospital from November 2015 to February 2018 were enrolled in the study.According to random grouping method,these patients were divided into two control group(n=68)and trial group(n=68).The patients in control group were treated by torasemide,however,the patients in trial group were treated by tolvaptan.The the therapeutic effects and the laboratory indexes in cluding left ventricular ejection fraction(LVEF),brain natriuretic peptide(BNP),24h urine volume as well as the levels of serum sodium,potassium,plasma osmotic pressure before and after treatment were observed and compared between the two groups.Results The total effective rate in treatment heart failure in trial group was 97.06%,and the total effective rate in treatment of diluent hyponatremia was 95.59%,both of them were significantly higher than those in control group(P<0.05).Before treatment there were no significant differences in laboratory indexes between the two groups(P>0.05).After treatment,the LVEF and BNP and 24h urine volume were improved in both groups,in which,the LVEF in trial group was significantly higher than that in control group,and the BNP in trial group was(1 130.54±152.62)ng/L,which was significantly lower than that in control group,moreover,the 24h urine volume in trial group was significantly higher than that in control group(P<0.05).Before treatment there were no significant differences in the serum levels of sodium,potassium and plasma osmotic pressure between the two groups(P>0.05).After treatment there were no significant differences in the serum levels of potassium between the two groups(P>0.05),however,the serum sodium levels and plasma osmotic pressure in trial group were significantly higher than those in control group(P<0.05).Conclusion therapeutic e

关 键 词：托拉塞米 托伐普坦 重症 心力衰竭 稀释性低钠血症 

分 类 号：R541.61[医药卫生—心血管疾病]