托伐普坦治疗75岁及以上难治性心力衰竭患者的临床疗效观察  

Efficacy of Tolvaptan on refractory heart failure in patients aged 75 years and older

作　　者：徐先静[1] 黄改荣[1] 刘雪亚 曹选超[1] 刘祥 高美华 Xu Xianjing;Huang Gairong;Liu Xueya;Cao Xuanchao;Liu Xiang;Gao Meihua(Department of Geriatrics,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院老年医学科,郑州450003

出　　处：《中华老年医学杂志》2020年第9期1038-1041,共4页Chinese Journal of Geriatrics

基　　金：河南省医学科技攻关计划项目(201702234)。

摘　　要：目的观察托伐普坦对75岁及以上难治性心力衰竭(心衰)患者的治疗效果。方法随机对照研究,68例75岁及以上难治性心衰患者数字抽签随机分为对照组38例和实验组30例,对照组患者在利尿、纠正水电解质紊乱等常规治疗基础上静脉给予左西孟旦及重组人脑钠肽。实验组30例在对照组基础加用托伐普坦15 mg,1次/d。比较治疗1周后两组患者的心衰改善效果。随访3个月,心衰再住院率、急诊干预次数和病死率的变化。结果治疗后实验组和对照组老年患者心衰症状均有减轻;实验组患者24 h尿量、体重较基线改变量高于对照组,(1470.5±200.6)ml比(972.5±201.7)ml、(-6.4±2.1)kg比(-2.8±1.9)kg;实验组患者6 min步行距离较基线改变量亦优于对照组,(189.3±13.7)m比(151.3±12.5)m(均P<0.05)。治疗后,实验组患者血清钠、左心室射血分数(LVEF)较基线变化值高于对照组,(5.2±2.1)μmol/L比(-1.1±2.4)μmol/L、(10.1±4.1)%比(7.0±4.0)%(均P<0.05),N端脑钠肽前体(NT-proBNP)降低,(-6670±1815.7)ng/L比(-5025.3±1876.7)ng/L(P<0.05)。两组治疗期间不良反应的发生率差异无统计学意义(均P>0.05)。实验组患者住院时间缩短,随访期间两组患者心衰再住院率、急诊干预次数、病死率差异无统计学意义(P>0.05)。结论加用托伐普坦可增加75岁及以上难治性心衰患者的尿量,改善心功能,纠正低钠血症,缩短住院天数,对肾功能无明显影响。Objective To evaluate the therapeutic effects of Tolvaptan on refractory heart failure in patients aged 75 years and older.Methods This was a randomized controlled trial.A total of 68 patients with refractory heart failure aged 75 years and older were divided into the control group(n=38)and the experimental group(n=30)by randomly generated numbers.Patients in the control group were given levosimendan and recom binant human brain natriuretic peptide intravenously plus routine treatments such as diuresis and electrolyte correction.In the experimental group.30 patients were given a single dose of 15 mg Tolvaptan per day in addition to what was received by the control group.The effects on heart failure were compared between the two groups 1 week after treatment.Changes in rehospitalization rate,emergency intervention frequency and mortality rate were recorded after a 3-month followup.Results Clinical symptoms of heart failure were alleviated in both the experimental and control groups after treatment.Improvements in 24-h urine volume,body weight and 6-minute walking distance were more significant in the experimental group than in the control group after treatment[(1470.5±200.6)ml us.(972.5±201.7)ml,(-6.4±2.1)kg us.(-2.8±1.9)kg.(189.3±13.7)m us.(151.3±12.5)m.P<0.05].Changes in serum sodium levels and improvement of LVEF were greater and reduction of N-terminal B type brain natriuretic peptide(NT-proBNP)levels was more significant in the experimental group than in the control group after treatment[(5.2±2.1)pmol/L vs.(-1.1±2.4)pmol/L.(10.1±4.1)%us.(7.0±4.0)%,(-6670±1815.7)ng/L vs.(-5025.3±1876.7)ng/L,P<0.05].There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The experimental group had shorter hospital stay s»while the rehospitalization ra te,emergency intervention times and mortality had no significant difference between the two groups during the follow-up period(P>0.05).Conclusions Addition of Tolvaptan to treatment can increase urine volume,improve car

关 键 词：心力衰竭 利尿药 托伐普坦 步行 

分 类 号：R541.6[医药卫生—心血管疾病]