托伐普坦与呋塞米治疗急性左心衰伴低钠血症的疗效及安全性对比  

Comparison of therapeutic effect and safety between tolvaptan and furosemide in treatment of acute left heart failure complicated with hyponatremia

作　　者：黄宇彬 蔡敏 陈金灶 HUANG Yu-bin;CAI Min;CHEN Jin-zao(Department of Cardiology,Putian First Hospital,Putian,Fujian,351100,China)

机构地区：[1]莆田市第一医院心内科,福建莆田351100

出　　处：《心血管康复医学杂志》2024年第6期766-771,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:本研究旨在比较托伐普坦与呋塞米治疗急性左心衰伴低钠血症的疗效及安全性。方法:选择2018年7月~2022年9月莆田市第一医院收治的慢性心力衰竭急性发作合并低钠血症患者95例,按照随机数字表法分为呋塞米组(49例,采取常规呋塞米静脉推注)和托伐普坦组(46例,口服托伐普坦治疗)。治疗7d后,对比两组患者临床疗效、心功能、电解质、血肌酐及药物不良反应发生情况。结果:治疗7d后,两组患者N末端B型利钠肽前体(NT-proBNP)水平均显著降低,左室射血分数(LVEF)和血钠水平均显著提高(P<0.05或<0.01);与呋塞米组比较,托伐普坦组血肌酐(SCr)[125.00(107.50,164.00)μmol/L比113.00(85.00,130.50)μmol/L]水平显著降低,血钾[3.60(3.20.4.20)μmol/L比3.90(3.60,4.60)μmol/L]水平显著升高(P<0.05或<0.01)。两组治疗后临床疗效、心功能和药物不良反应方面均无显著差异(P均>0.05)。结论:口服托伐普坦治疗急性心力衰竭安全有效,其效果不劣于静脉注射呋塞米,尤其是对低钠血症患者,可应用于急性心力衰竭的短期治疗。Objective:This study aims to compare the therapeutic effect and safety between tolvaptan and furosemide in treatment of acute left heart failure complicated with hyponatremia.Methods:This randomized controlled study enrolled 95 patients with acute exacerbation of chronic heart failure complicated with hyponatremia admitted Putian First Hospital between July 2018 and September 2022.They were divided into furosemide group(n=49,routine furosemide intravenous injection)and tolvaptan group(n=46,tolvaptan p.o.).After 7d treatment,clinical therapeutic effect,cardiac function,electrolyte,serum creatinine(SCr)and incidence of adverse drug reactions were compared between two groups.Results:After 7d treatment,patients in two groups had significant lower level of N terminal pro natriuretic peptide(NT-proBNP),and significant higher left ventricular ejection fraction(LVEF)and blood sodium level(P<0.05 or<0.01).Compared with patients in furosemide group,those in tolvaptan group had significant lower SCr level[125.00(107.50,164.00)μmol/L vs.113.00(85.00,130.50)μmol/L],and significant higher blood potassium level[3.60(3.20.4.20)μmol/L vs.3.90(3.60,4.60)μmol/L](P<0.05 or<0.01).There were no significant difference in therapeutic effect,cardiac function and incidence of adverse drug reactions between two groups after treatment(P>0.05 all).Conclusion:Tolvaptan p.o.is safe and effective in treatment of acute heart failure,and its effect is not inferior to intravenous injection of furosemide,especially for those with hyponatremia,which could be applied for short-term treatment of acute heart failure.

关 键 词：心力衰竭 低钠血症 托伐普坦 呋塞米 

分 类 号：R541.61[医药卫生—心血管疾病]