托伐普坦治疗高龄慢性心力衰竭伴肾功能不全的临床效果及安全性研究  

Efficacy and safety of tolvaptan in the treatment of elderly chronic heart failure patients with renal insufficiency

作　　者：杨翔云 刘云 赵红伟 吴炎 张艳宁 Yang Xiangyun;Liu Yun;Zhao Hongwei;Wu Yan;Zhang Yanning(Department of Third Cardre′s Ward,General Hospital of Northern Theater Command,Shenyang 110003,China;Department of Nephrology,General Hospital of Northern Theater Command,Shenyang 110003,China)

机构地区：[1]北部战区总医院干诊三科,沈阳110003 [2]北部战区总医院肾内科,沈阳110003

出　　处：《中国临床实用医学》2022年第5期18-23,共6页China Clinical Practical Medicine

基　　金：辽宁省科学技术计划项目(2015225010)。

摘　　要：目的探讨托伐普坦治疗高龄慢性心力衰竭伴肾功能不全的临床效果及安全性。方法本研究为回顾性队列研究, 选取2018年7月至2021年7月北部战区总医院干诊三科收治的92例慢性心力衰竭合并肾功能不全的患者, 男64例, 女28例, 年龄(92.9±5.6)岁, 年龄范围为85~103岁。根据患者选用利尿剂的不同将其分为呋塞米组与托伐普坦组, 每组46例。呋塞米组采用呋塞米等常规抗心力衰竭方法治疗, 托伐普坦组在呋塞米组的基础上加用托伐普坦治疗。比较两组治疗前、治疗7 d后心肝肾功能、电解质等指标的变化;比较两组治疗后尿量、住院时间及不良反应。随访3个月, 比较两组患者因心力衰竭再住院情况。结果治疗7 d后, 呋塞米组血清肌酐[(139.5±22.8)μmol/L]高于治疗前[(131.5±21.5)μmol/L], 托伐普坦组血清肌酐[(122.3±22.0)μmol/L]低于治疗前[(129.9±26.9)μmol/L], 血清钠[(139.4±3.4)mmol/L]高于治疗前[(133.5±3.5)mmol/L], 差异有统计学意义(P<0.05)。治疗7 d后, 托伐普坦组血清肌酐低于呋塞米组、血清钠高于呋塞米组, 差异有统计学意义(P<0.05)。呋塞米组患者治疗7 d后体质量[(62.6±8.5)kg]低于治疗前[(64.5±9.2)kg];托伐普坦组患者治疗7 d后体质量[(63.5±8.4)kg]低于治疗前[(66.0±9.6)kg], 差异有统计学意义(P<0.05)。呋塞米组治疗前尿量为(1 277.9±432.8)ml, 治疗7 d后日均尿量为(2 131.5±354.2)ml, 托伐普坦组治疗前尿量为(1 233.4±423.5)ml, 治疗7 d后日均尿量为(2 310.5±395.3)ml, 组间比较差异有统计学意义(P<0.05)。治疗7 d后, 呋塞米组N末端B型利钠肽前体[NT-proBNP, (2 225.4±622.4)g/L]低于治疗前[(3 599.4±718.3)g/L];左室射血分数[LVEF, (40.7±3.1)%]高于治疗前[(39.2±3.6)%];托伐普坦组NT-proBNP[(1 759.5±440.5)g/L]低于治疗前[(3 879.6±776.4)g/L];LVEF[(41.9±2.6)%]高于治疗前[(38.5±3.9)%], 差异有统计学意义(P<0.05)。治疗7 d后, 托伐普坦组NT-proBNP低于Objective To investigate the clinical efficacy and safety of tolvaptan in elderly chronic heart failure patients with renal insufficiency.Methods This study was a retrospective cohort study,a total of 92 elderly chronic heart failure patients with renal insufficiency in the Third Cardre′s Ward department of the General Hospital of Northern Theater Command from July 2018 to July 2021,including 64 males and 28 females,aged(92.9±5.6)years old,ranging from 85 to 103 years old,they were divided into furrosemide group and toraputan group,with 46 patients in each group.Patients in furosemide group were treated with furosemide and other routine anti-heart failure methods,while patients in torvalptan group were treated with torvalptan in addition to furosemide group,the changes of cardiac,hepatic and renal functions,electrolytes,urine volume,hospitalization time and side effects were compared between the two groups before and 7 days after treatment.The patients were followed up for 3 months to compare the rehospitalization for heart failure between the two groups.Results After 7 days of treatment,the serum creatinine of furosemide group[(139.5±22.8)μmol/L]was higher than that of before treatment[(131.5±21.5)μmol/L],the serum creatinine of torvastatin group[(122.3±22.0)μmol/L]was lower than that of before treatment[(129.9±26.9)μmol/L],the serum sodium[(139.4±3.4)mmol/L]was higher than that of before treatment[(133.5±3.5)mmol/L],the differences were statistically significant(P<0.05).After 7 days of treatment,serum creatinine was lower and serum sodium was higher in the atorvastatin group than in the furosemide group,the differences were statistically significant(P<0.05).The body mass of the patients in the furosemide group at 7 days after treatment[(62.6±8.5)kg]was lower than before treatment[(64.5±9.2)kg],the body mass of the patients in the torvastatin group at 7 days after treatment[(63.5±8.4)kg]was lower than before treatment[(66.0±9.6)kg],the differences were statistically significant(P<0.05).The urine

关 键 词：慢性心力衰竭 肾功能不全 高龄 托伐普坦 

分 类 号：R541.6[医药卫生—心血管疾病] R692.5[医药卫生—内科学]