托伐普坦联合重组人脑利钠肽在老年患者急性左心衰竭合并急性心肾综合征中的有效性  

Efficacy of tolvaptan combined with recombinant human brain natriuretic peptide in the treatment of elderly patients with acute left heart failure complicated with acute cardiorenal syndrome

作　　者：何晓全 高翔宇[1] 周力[1] 邱惠[1] 赵树梅[1] 姚道阔[1] 李东宝[1] 沈爱东[1] 陈晖[1] 赵慧强[1] HE Xiaoquan;GAO Xiangyu;ZHOU Li;QIU Hui;ZHAO Shumei;YAO Daokuo;LI Dongbao;SHEN Aidong;CHEN Hui;ZHAO Huiqiang(Cardiovascular Center,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing,100015,China)

机构地区：[1]首都医科大学附属北京友谊医院心脏中心,北京100015

出　　处：《临床心血管病杂志》2021年第12期1137-1141,共5页Journal of Clinical Cardiology

基　　金：北京友谊医院科研启动基金资助项目(No:yyqdkt2017-33);北京市医管局科研培育计划(No:PX2017030);北京市属医院科研培育计划项目(No:PX2020006);北京市临床重点专科项目经费资助(No:京卫医[2018]204号)。

摘　　要：目的:观察在标准药物治疗基础上应用托伐普坦联合重组人脑利钠肽对急性左心衰竭合并急性心肾综合征老年患者的有效性和安全性。方法:回顾性分析2018年1月—2021年6月首都医科大学附属北京友谊医院收治的急性左心衰竭老年患者,经传统利尿剂等心力衰竭药物治疗后仍有液体潴留且合并急性心肾综合征,在标准治疗基础上加用7.5~15.0 mg/d托伐普坦口服联合重组人脑利钠肽持续静脉泵入3~7 d的患者共20例。对比治疗前后患者心功能、肾功能和电解质变化,并观察血压、心率、呼吸困难、体重和尿量改变等。结果:经托伐普坦联合重组人脑利钠肽治疗后,患者体重、心率、舒张压较治疗前下降,尿量显著增加(均P<0.05)。20例患者水肿均改善,80%的患者NYHA心功能分级改善。18例呼吸困难患者中有16例明显减轻(88.9%),治疗后患者血肌酐、血尿素氮、尿素氮肌酐比值、估算肾小球滤过率、N末端B型利钠肽前体水平、左心室舒张末期内径、左心室射血分数、右心室前后径、收缩期肺动脉压力与治疗前比较均显著改善(均P<0.05),血钠较治疗前升高(P=0.046)。治疗期间未出现因血钠过高导致的精神症状及严重低钾血症、血流动力学障碍、心室颤动、猝死、心源性休克等不良心血管事件。结论:急性左心衰竭合并急性心肾综合征老年患者在标准治疗基础上应用托伐普坦联合重组人脑利钠肽可有效改善左心室功能和肾功能,缓解临床症状,降低肾前性肾损伤风险。Objective:To observe the efficacy and safety of tolvaptan combined with recombinant human brain natriuretic peptide on the basis of standard drug therapy in elderly patients with acute left heart failure complicated with acute cardiorenal syndrome.Methods:Twenty elderly patients with acute left heart failure admitted to Beijing Friendship Hospital,Capital Medical University from January 2018 to June 2021 were retrospective analyzed.All patients still presented fluid retention and complicated with acute cardiorenal syndrome after traditional diuretics and other standard heart failure medication,7.5-15.0 mg/d tolvaptan and recombinant human brain natriuretic peptide were added on the basis of standard drug therapy for 3-7 days.Cardiac function,renal function,and electrolyte before and after treatment were compared,changes in blood pressure and heart rate,dyspnea symptoms,body weight and urine volume were observed.Results:Bodyweight,heart rate and diastolic blood pressure decreased,while urine output increased significantly after the treatment of tolvaptan combined with recombinant human brain natriuretic peptide(all P<0.05).Edema was significantly relieved in all 20 patients,and NYHA cardiac function classification improved in 80%of all patients,16 of 18 patients with dyspnea symptoms relieved significantly(88.9%).The serum creatinine,blood urea nitrogen,urea nitrogen creatinine ratio,estimated glomerular filtration rate(eGFR),N-terminal fragment of the brain natriuretic peptide precursor(NT-proBNP),left ventricular end diastolic diameter,left ventricular ejection fraction,right ventricular anteroposterior diameter,and systolic pulmonary artery pressure were significantly improved after the treatment(all P<0.05),and the serum sodium was higher(P=0.046).During the treatment,there was no psychiatricsy mptoms caused by hypernatremia,severe hypokalemia,adverse cardiovascular events such as hemodynamic disorders,ventricular fibrillation,sudden death,and cardiogenic shock.Conclusion:Tolvaptan combined with recombinant hu

关 键 词：急性左心衰竭 托伐普坦 重组人脑利钠肽 急性心肾综合征 利尿剂 

分 类 号：R541.6[医药卫生—心血管疾病]