托伐普坦治疗老年重症心力衰竭伴中重度低钠血症有效性和安全性研究
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摘要
目的探讨托伐普坦治疗老年重症心力衰竭伴中重度低钠血症有效性和安全性研究。方法选取2013年1月—2017年12月在空军军医大学唐都医院诊治的老年重症心力衰竭伴中重度低钠血症患者40例,随机分为对照组(20例)和观察组(20例),对照组患者采用常规方法治疗,观察组患者在常规方法的治疗基础上给予托伐普坦治疗,连续治疗7 d后比较两组患者治疗前后左室射血分数(LVEF)、左室舒张末期压力(LVEDP)、肺动脉压(PAP)、心输出量(CO)、血钠、血渗透压及24 h尿量及不良反应的发生率。结果治疗后,两组患者的LVEF和CO显著升高,而LVEDP和PAP显著降低,差异具有统计学意义(P<0.05);且观察组患者的LVEF和CO显著高于对照组,而LVEDP和PAP显著低于对照组,差异具有统计学意义(P<0.05)。治疗后,两组患者的血钠、血渗透压及24 h尿量均明显升高,同组治疗前后比较差异有统计学意义(P<0.05);且观察组患者的血钠、血渗透压及24 h尿量均显著高于对照组,差异具有统计学意义(P<0.05)。观察组患者不良反应发生率为15.00%,对照组患者不良反应发生率为25.00%,差异无统计学意义。结论托伐普坦治疗老年重症心力衰竭伴中重度低钠血症的临床效果较好,可显著改善患者的心功能及血钠值,安全性较高。
Objective To investigate the effectiveness and safety of tolvaptan in the treatment of senile severe heart failure and moderate to severe hyponatremia.Methods 40 cases senile severe heart failure and moderate to severe hyponatremia patients from January 2013 to December 2017 in our hospital,random divided into control group(20 cases) and observation group(20 cases),the control group was given conventional method,the observation group was given conventional method based on the given tolvaptan treatment,compared with the left ventricular ejection fraction,left ventricular end diastolic pressure,pulmonary artery pressure,cardiac output,blood sodium,plasmaosmotic pressure and 24 h urine volume before and after treatment of the two groups,and the adverse reaction.Results Before treatment,compared with the LVEF,LVEDP,PAP,CO,blood sodium,plasmaosmotic pressure and24 h urine volume of the two groups,the difference was not statistically significant.After treatment,compared with the control group,the LVEF and CO of the observation group significantly increased,but LVEDP and PAP significantly decreased,the difference was statistically significant(P < 0.05).After treatment,compared with the control group,the blood sodium,plasmaosmotic pressure and 24 h urine volume of the observation group significantly increased,the difference was statistically significant(P < 0.05);The incidence of adverse reaction of the observation group is three cases(15.00%),the incidence of adverse reaction of the control group is five cases(25.00%),the difference was not statistically significant.Conclusion Tolvaptan has good effect in the treatment of senile severe heart failure and moderate to severe hyponatremia,can significantly improved the cardiac function and blood sodium,the safety is high.
Objective To investigate the effectiveness and safety of tolvaptan in the treatment of senile severe heart failure and moderate to severe hyponatremia.Methods 40 cases senile severe heart failure and moderate to severe hyponatremia patients from January 2013 to December 2017 in our hospital,random divided into control group(20 cases) and observation group(20 cases),the control group was given conventional method,the observation group was given conventional method based on the given tolvaptan treatment,compared with the left ventricular ejection fraction,left ventricular end diastolic pressure,pulmonary artery pressure,cardiac output,blood sodium,plasmaosmotic pressure and 24 h urine volume before and after treatment of the two groups,and the adverse reaction.Results Before treatment,compared with the LVEF,LVEDP,PAP,CO,blood sodium,plasmaosmotic pressure and24 h urine volume of the two groups,the difference was not statistically significant.After treatment,compared with the control group,the LVEF and CO of the observation group significantly increased,but LVEDP and PAP significantly decreased,the difference was statistically significant(P < 0.05).After treatment,compared with the control group,the blood sodium,plasmaosmotic pressure and 24 h urine volume of the observation group significantly increased,the difference was statistically significant(P < 0.05);The incidence of adverse reaction of the observation group is three cases(15.00%),the incidence of adverse reaction of the control group is five cases(25.00%),the difference was not statistically significant.Conclusion Tolvaptan has good effect in the treatment of senile severe heart failure and moderate to severe hyponatremia,can significantly improved the cardiac function and blood sodium,the safety is high.
引文
[1]陈曦,解珍,姜妤,等.托伐普坦与托拉塞米治疗重症心力衰竭伴稀释性低钠血症临床疗效的对比研究[J].实用心脑肺血管病杂志,2017,25(4):67-69.
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[9]高鹏,寇广亚,武延海.托伐普坦治疗老年慢性充血性心力衰竭合并低钠血症及利尿剂抵抗的近期疗效[J].中国循证心血管医学杂志,2017,9(2):159-163.
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[11]王震,顾翔.不同剂量托伐普坦片对慢性心力衰竭合并低钠血症老年患者的疗效观察[J].中华老年多器官疾病杂志,2017,16(8):574-577.
[12]邹艳慧.托伐普坦结合苯磺酸氨氯地平治疗老年心衰合并高血压、低钠血症的效果[J].中西医结合心血管病电子杂志,2017,5(19):46-47.
[13]施骅,叶斌.血管加压素V2受体拮抗剂托伐普坦治疗肝硬化合并低钠血症36例临床观察[J].浙江中西医结合杂志,2017,27(1):29-31.
[14]季雪峰,沈秋生,沈怡.顽固性心力衰竭合并中重度稀释性低钠血症治疗方案探讨[J].数理医药学杂志,2017,30(5):653-654.
[2]薛君.托伐普坦对急性心肌梗死后心力衰竭合并低钠血症患者的疗效及安全性观察[J].中国药物与临床,2017,17(1):113-115.
[3]谢幸洪,齐永乐.托伐普坦治疗心力衰竭合并低钠血症患者的效果及安全性探析[J].河南医学研究,2014,23(10):106-107.
[4]王鲁奇,李靖.托伐普坦对慢性心力衰竭患者容量负荷及血清钠水平的影响[J].山东医药,2017,57(20):63-65.
[5]刘婕,徐予.托伐普坦治疗顽固性心力衰竭合并低钠血症的效果观察[J].中国当代医药,2015,22(19):41-43.
[6]杨靖,任雨笙,厉娜,等.托伐普坦治疗合并低钠血症及利尿剂抵抗的心力衰竭[J].第二军医大学学报,2015,36(10):1133-1137.
[7]高阳,于海波,梁延春,等.托伐普坦治疗心衰合并低钠血症患者临床疗效观察[J].临床军医杂志,2017,45(8):796-798.
[8]孙卫国.托伐普坦联合利尿剂治疗对心力衰竭(心衰)伴水潴留患者血钠水平及预后的影响[J].罕少疾病杂志,2017,24(2):33-34,37.
[9]高鹏,寇广亚,武延海.托伐普坦治疗老年慢性充血性心力衰竭合并低钠血症及利尿剂抵抗的近期疗效[J].中国循证心血管医学杂志,2017,9(2):159-163.
[10]李冰,何敏,童亚良,等.托伐普坦治疗慢性心力衰竭患者低钠血症的疗效及安全性评价[J].吉林大学学报(医学版),2013,39(5):995-998.
[11]王震,顾翔.不同剂量托伐普坦片对慢性心力衰竭合并低钠血症老年患者的疗效观察[J].中华老年多器官疾病杂志,2017,16(8):574-577.
[12]邹艳慧.托伐普坦结合苯磺酸氨氯地平治疗老年心衰合并高血压、低钠血症的效果[J].中西医结合心血管病电子杂志,2017,5(19):46-47.
[13]施骅,叶斌.血管加压素V2受体拮抗剂托伐普坦治疗肝硬化合并低钠血症36例临床观察[J].浙江中西医结合杂志,2017,27(1):29-31.
[14]季雪峰,沈秋生,沈怡.顽固性心力衰竭合并中重度稀释性低钠血症治疗方案探讨[J].数理医药学杂志,2017,30(5):653-654.