托伐普坦联合呋塞米治疗超高龄Ⅰ型心肾综合征患者6例

Efficacy of tolvaptan added to furosemide in six very elderly patients with Ⅰ types cardiorenal syndrome

目的观察托伐普坦联合呋塞米治疗Ⅰ型心肾综合征超高龄患者的疗效及安全性。方法6例超高龄Ⅰ型心肾综合征患者，平均年龄（91．2±6．7）岁，在常规治疗基础上，予口服托伐普坦7．5—15mg·d^-1加呋塞米静脉滴注40～100mg·d^-1，疗程7d。观察并记录患者每日血压、尿量、周围静脉压、心衰体征及不良事件。每3日检查肝、肾功能，N末端B型脑钠肽前体（N-pro-BNP），胱抑素C及电解质，进行疗效及安全性评估。结果与治疗前相比，所有患者在治疗第3日尿量显著增加[（2158．3±366．6）mLVS．（753．3±110．1）mL（治疗前），P〈Q01]；周围静脉压显著下降[（11.5±0．8）cmH2Ovs．（165±1．9）cmH2O，P〈0．05]；心衰体征缓解，血肌酐及胱抑素较治疗前下降，分别为[（108．6±50．6）μmol·L^-1vs．（153．64-77．5）μmol·L^-1，P〈0．05]和[（3．28±1．51）mg·L^-1vs．（4．60±2．54）mg·L^-1，P〈0．05]，N—pro-BNP下降显著[（5005．04-2656．3）Pg·mL^-1vs．（8368．3±4545．7）Pg·mL^-1，P〈0．01]。患者均未发生高钠血症，未出现明显口渴及肝功能损害。结论托伐普坦联合呋塞米有效纠正Ⅰ型心肾综合征超高龄患者的心衰症状，增加尿量，减轻肾损伤。

AIM To evaluate the efficacy of tolvaptan in combination with furosemide in very elderly patients with I types cardio renal syndrome. METHODS Six very elderly patients with I types cardio renal syndrome were enrolled in this study, average age （91.2 ± 6.7） years. All patients were given conventional treatment, in addition tolvaptan was administered as a single oral dose of 7.5 - 15 mg per day and furosemide was administered as an intravenous dose of 40 - 100 mg per day depending on the case for 7 days. The endpoints investigated were blood pressure, urinary output, peripheral venous pressure, physical signs of heart failure, the function of liver and kidney, serum levels of N-teminal pro brain natriuretic peptide （N-pro-BNP） and cystatin C, the serum sodium concentration and all adverse events were observed. RESULTS Urine volume of all patients increased significantly after treatment for 48 - 72 h compared with treatment for 24 h by 1 000 - 2 000 mL per day. After treatment for 72 h, urine volume of all patients increased significantly compared with before treatment （（2 158.3 ± 366.6） mL vs. （753.3 ± 110.1） mL, P 〈 0.01）. The peripheral venous pressure was reduced remarkably （（11.5 ± 0.8） cmH2O vs. （16.5 ± 1.9） cmH2O, P 〈 0.05）. The changes of sign of heart failure were released significiantly, blood levels of creatinine （ （ 108.6 ± 50.6） μmol·L^-1vs. （ 153.6 ± 77.5） μmol·L^-1, P 〈 0.05）, serum eystatin C （（3.28 ± 1.51） mg·L^-1 vs. （4.60 ± 2.54） mg·L^-1vs. P 〈 0.05） and N-pro-BNP （（5 005.0± 2 656.3） pg·mL^-1 vs. （8 368.3 ± 4 545.7） pg·mL^-1, P 〈 0.01） were reduced significiantly. Hypernatremia didn＇ t happened. There were no drug related adverse events of thirst and liver dysfunction. CONCLUSION Adding tolvaptan to furosemide could effectively increase urine volume, and reduced kidney injury and released the signs of heart failure of very elderly patients with I types cardiorenal syndrome.