托伐普坦联合左西孟旦治疗顽固性心力衰竭的疗效观察

Efficacy Observation of Tolvaptan Combined with Levosimendan in the Treatment of Severe Decompensated Heart Failure

目的:评价托伐普坦联合左西孟旦治疗顽固性心力衰竭的临床疗效。方法:100例顽固性心力衰竭患者按照随机数字表法分为基础治疗组、托伐普坦组、左西孟旦组和联合用药组,各25例。基础治疗组患者给予洋地黄、血管紧张素转换酶抑制剂、螺内酯、呋塞米等综合治疗;托伐普坦组患者在基础治疗组基础上加用托伐普坦(每次15 mg,qd);左西孟旦组患者在基础治疗组基础上加用左西孟旦[0.1μg/(kg·min),持续滴注24 h];联合用药组患者在基础治疗组基础上加用托伐普坦(每次15 mg,qd)和左西孟旦[0.1μg/(kg·min),持续滴注24 h]。观察4组患者治疗前与治疗7 d后的血压、心率、呼吸困难和全身临床症状改善程度、24 h尿量变化;抽取静脉血,测定钠离子、钾离子、肾功能、脑钠肽(BNP)等相关指标的变化;采用超声心动图测定左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、左室射血分数(LVEF)、心脏指数(CI)等指标的变化。结果:给药7 d后,与基础治疗组比较,托伐普坦组、左西孟旦组和联合用药组患者的血压、心率显著下降,呼吸困难和全身临床症状显著改善,24 h尿量显著增加,BNP显著下降,LVEDd和LVESd均显著减小,LVEF明显改善,CI明显升高,差异均有统计学意义(P<0.05);其中,联合用药组患者改变尤为明显,与托伐普坦组、左西孟旦组比较,差异均有统计学意义(P<0.05);但血清电解质及肾功能没有明显差异。结论:托伐普坦和左西孟旦联用治疗顽固性心力衰竭疗效显著,其效果优于单一用药。

OBJECTIVE：To evaluate therapeutic efficacy of tolvaptan combined with levosimendan in the treatment of severe congestive heart failure（CHF）. METHODS：100 severe CHF patients were randomly divided into basic treatment group,tolvaptan group,levosimendan group and drug combination group,with 25 cases in each group. All groups were given Digitalis,ACEI,spirolactone,furosemidum and other comprehensive treatment;tolvaptan group was additionally given tolvaptan（15 mg/time,qd）;levosimendan group given levosimendan [0.1 μg/（kg·min）] for consecutive 24 h;drug combination given tolvaptan（15 mg/time,qd）and levosimendan [0.1 μg/（kg·min）] for consecutive 24 h. Blood pressure,heart rate,dyspnea,the improvement of systemic clinical symptoms and 24 h urine volume were observed in 4 groups before and 7 d after treatment. The venous blood samples were collected to determine the change of Na＋,K＋,renal function,BNP and other related indicators;the changes of LVEDd,LVESd,LVEF,CI and other indicators were determined by UCG. RESULTS：7 days after administration,compared with basic treatment group,the blood pressure,heart rate,BNP,LVEDd and LVESd of tolvaptan group,levosimendan group and drug combination group decreased significantly,while dyspnea,systemic clinical symptoms and LVEF were improved significantly,and 24 h urine volume and CI increased significantly,with statistical significance（P〈0.05）. The change of drug combination group was more significant,there was statistical significance,compared with tolvaptan group and levosimendan group（P〈0.05）. There was no significant difference in serum electrolytes and renal function. CONCLUSIONS：Tolvaptan combined with levosimendan is effective and better than drug alone in the treatment of severe CHF.