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的效果比较
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摘要
目的观察分析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的效果。方法选取2015年11月至2018年2月收治的136例重症心力衰竭伴稀释性低钠血症患者为观察对象。依据计算机随机分组法将所有患者分为2组,其中68例患者采用托拉塞米治疗,设为对照组;另68例患者采用托伐普坦治疗,设为试验组。比较2组患者心力衰竭疗效、稀释性低钠血症疗效,比较2组患者治疗前后实验室指标[左心室射血分数(LVEF)、脑钠肽(BNP)、24 h尿量]、血钠、血钾及血浆渗透压各指标的水平变化情况。结果 2组治疗效果比较,试验组心力衰竭总有效率为97. 06%、稀释性低钠血症总有效率为95. 59%,均高于对照组,差异有统计学意义(P <0. 05); 2组治疗前各实验室指标比较,差异无统计学意义(P> 0. 05); 2组治疗后LVEF、BNP、24 h尿量均较治疗前改善,其中试验组LVEF为(34. 56±4. 88)%,高于对照组; BNP为(1 130. 54±152. 62) ng/L,低于对照组; 24 h尿量为(2 156. 66±220. 57) ml,多于对照组,差异有统计学意义(P <0. 05); 2组治疗前血钠、血钾及血浆渗透压比较,差异无统计学意义(P> 0. 05);治疗后2组血钾水平比较,差异无统计学意义(P> 0. 05);试验组血钠与血浆渗透压均高于对照组,差异有统计学意义(P <0. 05)。结论相比较于托拉塞米,托伐普坦治疗重症心力衰竭伴稀释性低钠血症的疗效更佳,可改善心功能,减轻水肿症状,值得推荐应用。
Objective To observe the therapeutic effects of tolvaptan and torasemide in treatment of severe heart failure complicated by diluent hyponatremia. Methods A total of 136 patients with severe heart failure complicated by diluent hyponatremia who were admitted and treated in our hospital from November 2015 to February 2018 were enrolled in the study.According to random grouping method,these patients were divided into two control group( n = 68) and trial group( n = 68).The patients in control group were treated by torasemide,however,the patients in trial group were treated by tolvaptan. The the therapeutic effects and the laboratory indexes in cluding left ventricular ejection fraction( LVEF),brain natriuretic peptide( BNP),24 h urine volume as well as the levels of serum sodium,potassium,plasma osmotic pressure before and after treatment were observed and compared between the two groups. Results The total effective rate in treatment heart failure in trial group was 97. 06%,and the total effective rate in treatment of diluent hyponatremia was 95. 59%,both of them were significantly higher than those in control group( P < 0. 05). Before treatment there were no significant differences in laboratory indexes between the two groups( P > 0. 05). After treatment,the LVEF and BNP and 24 h urine volume were improved in both groups,in which,the LVEF in trial group was significantly higher than that in control group,and the BNP in trial group was( 1 130. 54 ±152. 62) ng/L,which was significantly lower than that in control group,moreover,the 24 h urine volume in trial group was significantly higher than that in control group( P < 0. 05). Before treatment there were no significant differences in the serum levels of sodium,potassium and plasma osmotic pressure between the two groups( P > 0. 05). After treatment there were no significant differences in the serum levels of potassium between the two groups( P > 0. 05),however,the serum sodium levels and plasma osmotic pressure in trial group were significantly higher than those in control group( P < 0. 05). Conclusion therapeutic effects of tolvaptan in treatment of severe heart failure complicated by diluent hyponatremia are superior to those of torasemide,the former can improve cardiac function,relieve edema symptoms,therefor,it is worthy of clinical application and promotion.
Objective To observe the therapeutic effects of tolvaptan and torasemide in treatment of severe heart failure complicated by diluent hyponatremia. Methods A total of 136 patients with severe heart failure complicated by diluent hyponatremia who were admitted and treated in our hospital from November 2015 to February 2018 were enrolled in the study.According to random grouping method,these patients were divided into two control group( n = 68) and trial group( n = 68).The patients in control group were treated by torasemide,however,the patients in trial group were treated by tolvaptan. The the therapeutic effects and the laboratory indexes in cluding left ventricular ejection fraction( LVEF),brain natriuretic peptide( BNP),24 h urine volume as well as the levels of serum sodium,potassium,plasma osmotic pressure before and after treatment were observed and compared between the two groups. Results The total effective rate in treatment heart failure in trial group was 97. 06%,and the total effective rate in treatment of diluent hyponatremia was 95. 59%,both of them were significantly higher than those in control group( P < 0. 05). Before treatment there were no significant differences in laboratory indexes between the two groups( P > 0. 05). After treatment,the LVEF and BNP and 24 h urine volume were improved in both groups,in which,the LVEF in trial group was significantly higher than that in control group,and the BNP in trial group was( 1 130. 54 ±152. 62) ng/L,which was significantly lower than that in control group,moreover,the 24 h urine volume in trial group was significantly higher than that in control group( P < 0. 05). Before treatment there were no significant differences in the serum levels of sodium,potassium and plasma osmotic pressure between the two groups( P > 0. 05). After treatment there were no significant differences in the serum levels of potassium between the two groups( P > 0. 05),however,the serum sodium levels and plasma osmotic pressure in trial group were significantly higher than those in control group( P < 0. 05). Conclusion therapeutic effects of tolvaptan in treatment of severe heart failure complicated by diluent hyponatremia are superior to those of torasemide,the former can improve cardiac function,relieve edema symptoms,therefor,it is worthy of clinical application and promotion.
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.实用心脑肺血管病杂志,2017,25:67-69.
2 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.中西医结合心血管病电子杂志,2017,5:46-47.
3 赵瑾,冯宪真,冯丽丽,等.托伐普坦在重症心力衰竭合并低钠血症患者中的应用效果分析.中国循证心血管医学杂志,2016,8:1008-1010.
4 Olin JL,Mitchell G,Cremisi H,et al. Experience with tolvaptan for euvolemic and hypervolemic hyponatremia in the acute care setting. Hosp pharm,2015,50:380-385.
5 杜国芳.托伐普坦治疗老年慢性心力衰竭合并低钠血症的临床疗效观察.山西医药杂志,2017,46:2919-2920.
6 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.数理医药学杂志,2017,30:653-654.
7 杨华,许臣洪,李欣.托伐普坦治疗慢性心力衰竭伴低钠血症的疗效及对患者心功能的影响.海南医学,2016,27:2762-2764.
8 Medar SS,Hsu DT,Ushay HM,et al. Serial measurement of aminoterminal Pro-B-Type natriuretic peptide predicts adverse cardiovascular outcome in children with primary myocardial dysfunction and acute decompensated heart failure. Pediatric Criti Care Medi,2015,16:529-534.
9 刘世秀.托伐普坦治疗充血性心力衰竭伴低钠血症患者的疗效观察.世界最新医学信息文摘,2016,16:82.
10 蒋月强,李瑞超.托伐普坦治疗小细胞肺癌伴抗利尿激素异常分泌综合征所致的低钠血症.中国医院药学杂志,2017,37:2281-2284.
11 Sulaiman K,Panduranga P,Al-Zakwani I,et al. Clinical characteristics,management,and outcomes of acute heart failure patients:observations from the Gulf acute heart failure registry(Gulf CARE). Eur Heart Fail,2015,17:374-384.
12 张卉,付长丛.氯吡格雷对急性心肌梗死合并心力衰竭患者血清炎性因子及超声心动图指标的影响.河北医药,2016,38:2447-2449.
13 张丽,陈伟.托伐普坦与托拉塞米在慢性心力衰竭急性发作患者中的疗效对比.中国循证心血管医学杂志,2017,9:1182-1184.
14 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.中华老年多器官疾病杂志,2017,16:574-577.
15 王艳红,魏军,张雨.托伐普坦治疗乙肝肝硬化失代偿期稀释性低钠血症的效果.临床与病理杂志,2017,37:1406-1411.
16 Dardas T,Li Y,Reed SD,et al. Incremental and independent value of cardiopulmonary exercise test measures and the Seattle Heart Failure Model for prediction of risk in patients with heart failure. J Heat Lung Transplant,2015,34:1017-1023.
17 胡玲玲,任江华.托伐普坦与托拉塞米治疗慢性心衰急性发作的疗效比较.西南国防医药,2017,27:338-340.
18 兰立志.托伐普坦片治疗老年肝硬化难治性腹水伴低钠血症患者的疗效及安全性评价.临床医药文献电子杂志,2016,3:6094.
19 Collins S,Storrow AB,Albert NM,et al. Early management of patients with acute heart failure:state of the art and future directions. A consensus document from the society for academic emergency medicine/heart failure society of america acute heart failure working group. J Car Fail,2015,21:27-43.
20 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.中国循证心血管医学杂志,2017,9:159-163.
21 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.临床军医杂志,2017,45:796-798.
2 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.中西医结合心血管病电子杂志,2017,5:46-47.
3 赵瑾,冯宪真,冯丽丽,等.托伐普坦在重症心力衰竭合并低钠血症患者中的应用效果分析.中国循证心血管医学杂志,2016,8:1008-1010.
4 Olin JL,Mitchell G,Cremisi H,et al. Experience with tolvaptan for euvolemic and hypervolemic hyponatremia in the acute care setting. Hosp pharm,2015,50:380-385.
5 杜国芳.托伐普坦治疗老年慢性心力衰竭合并低钠血症的临床疗效观察.山西医药杂志,2017,46:2919-2920.
6 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.数理医药学杂志,2017,30:653-654.
7 杨华,许臣洪,李欣.托伐普坦治疗慢性心力衰竭伴低钠血症的疗效及对患者心功能的影响.海南医学,2016,27:2762-2764.
8 Medar SS,Hsu DT,Ushay HM,et al. Serial measurement of aminoterminal Pro-B-Type natriuretic peptide predicts adverse cardiovascular outcome in children with primary myocardial dysfunction and acute decompensated heart failure. Pediatric Criti Care Medi,2015,16:529-534.
9 刘世秀.托伐普坦治疗充血性心力衰竭伴低钠血症患者的疗效观察.世界最新医学信息文摘,2016,16:82.
10 蒋月强,李瑞超.托伐普坦治疗小细胞肺癌伴抗利尿激素异常分泌综合征所致的低钠血症.中国医院药学杂志,2017,37:2281-2284.
11 Sulaiman K,Panduranga P,Al-Zakwani I,et al. Clinical characteristics,management,and outcomes of acute heart failure patients:observations from the Gulf acute heart failure registry(Gulf CARE). Eur Heart Fail,2015,17:374-384.
12 张卉,付长丛.氯吡格雷对急性心肌梗死合并心力衰竭患者血清炎性因子及超声心动图指标的影响.河北医药,2016,38:2447-2449.
13 张丽,陈伟.托伐普坦与托拉塞米在慢性心力衰竭急性发作患者中的疗效对比.中国循证心血管医学杂志,2017,9:1182-1184.
14 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.中华老年多器官疾病杂志,2017,16:574-577.
15 王艳红,魏军,张雨.托伐普坦治疗乙肝肝硬化失代偿期稀释性低钠血症的效果.临床与病理杂志,2017,37:1406-1411.
16 Dardas T,Li Y,Reed SD,et al. Incremental and independent value of cardiopulmonary exercise test measures and the Seattle Heart Failure Model for prediction of risk in patients with heart failure. J Heat Lung Transplant,2015,34:1017-1023.
17 胡玲玲,任江华.托伐普坦与托拉塞米治疗慢性心衰急性发作的疗效比较.西南国防医药,2017,27:338-340.
18 兰立志.托伐普坦片治疗老年肝硬化难治性腹水伴低钠血症患者的疗效及安全性评价.临床医药文献电子杂志,2016,3:6094.
19 Collins S,Storrow AB,Albert NM,et al. Early management of patients with acute heart failure:state of the art and future directions. A consensus document from the society for academic emergency medicine/heart failure society of america acute heart failure working group. J Car Fail,2015,21:27-43.
20 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.中国循证心血管医学杂志,2017,9:159-163.
21 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.临床军医杂志,2017,45:796-798.