托伐普坦在急性心肌梗死后心力衰竭合并低钠血症治疗中的疗效与安全性  

Efficacy and safety of tolvaptan in treatment of heart failure combined with hyponatremia after acute myocardial infarction

作　　者：裴丽峰 韩英 PEI Lifeng;HAN Ying(Department of Cardiology,Liaoning Jinqiu Hospital,Shenyang 110016,China)

机构地区：[1]辽宁省金秋医院心内科,沈阳110016

出　　处：《药学服务与研究》2021年第3期175-180,共6页Pharmaceutical Care and Research

基　　金：辽宁省科学技术计划项目(2012020121-201)。

摘　　要：目的:研究托伐普坦治疗急性心肌梗死后心力衰竭合并低钠血症的疗效与安全性。方法:采用前瞻性研究方法,收集2016年3月-2018年9月在辽宁省金秋医院诊治的急性心肌梗死后心力衰竭合并低钠血症患者100例,按随机数字表法分为两组,每组50例。对照组仅给予强心药、利尿药、β受体拮抗剂、血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂治疗,观察组在此基础上加用托伐普坦治疗。随访一个月,测定两组患者治疗前后的体重、尿量、血钠浓度、心功能指标[E峰、E/A值、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、血压、心率、血清脑钠肽(BNP)和血清肌酐水平,观察心力衰竭症状和体征,记录两组患者药品不良反应(adverse drug reactions,ADRs)发生情况。结果:治疗后观察组患者的血钠浓度和尿量显著高于对照组,体重显著低于对照组(P<0.05)。与治疗前比较,治疗后两组患者的E峰、E/A值、LVEF均升高,LVEDD均降低,且观察组上述各指标显著优于对照组(P<0.05)。治疗后观察组患者血清BNP和肌酐水平显著低于对照组(P<0.05),肺部湿啰音面积>50%肺野、中重度呼吸困难、中重度颈静脉充盈的发生率和美国纽约心脏病学会(NYHA)分级Ⅲ~Ⅳ级的比例均显著低于对照组(P<0.05)。观察组尿频发生率和口渴发生率显著低于对照组(24.0%vs 36.0%,20.0%vs 34.0%,P<0.05)。结论:与常规治疗比较,加用托伐普坦治疗急性心肌梗死后心力衰竭合并低钠血症患者,缓解心力衰竭症状,效果更好,更利于缓解低钠血症,有助于改善心功能,保护肾功能,且不会增加不良心血管事件,安全性较高。Objective:To study the efficacy and safety of tolvaptan in treatment of heart failure combined with hyponatremia after acute myocardial infarction.Methods:In this prospective study,100 patients with heart failure and hyponatremia after acute myocardial infarction who received medical care from March 2016 to September 2018 in Liaoning Jinqiu Hospital were recruited as study subjects,and were randomly divided into 2 groups,each consisting of 50 cases.The patients in the control group were treated with cardiotonic,diuretic,beta receptor antagonist and angiotensin converting enzyme inhibitors/angiotensin receptor inhibitors,while the patients in the observation group were additionally treated with tolvaptan.The patients in both groups had one-month medical follow-up.The body weight,urine output,blood sodium concentration,cardiac function indexes,i.e.E peak,E/A value,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),blood pressure,heart rate,serum levels of brain natriuretic peptide(BNP)and creatinine,as well as symptoms and signs of heart failure,were detected and observed before and after treatment.The rates of adverse drug reactions(ADRs)in the patients of the 2 groups were recorded as well.Results:After treatment,the blood sodium concentration and urine output of the patients in the observation group were significantly higher than those of the patients in the control group(P<0.05),and the weight of the patients in the observation group was significantly lower than that of the patients in the control group(P<0.05).As compared with those before treatment,the E peaks,E/A values and LVEF all significantly elevated,and LVEDD significantly decreased in the patients of the 2 groups after treatment,with the indexes of the patients in the observation group being significantly better than those in the control group(P<0.05).After treatment,the serum BNP and creatinine levels of the patients in the observation group were significantly lower than those of the control group(P<0.05).The inci

关 键 词：托伐普坦 急性心肌梗死 心力衰竭 低钠血症 疗效 安全性 

分 类 号：R972.4[医药卫生—药品] R541.6[医药卫生—药学]