托伐普坦治疗难治性心力衰竭患者效果的观察

Efficacy of tolvaptan in patients with refractory heart failure

目的观察难治性心力衰竭患者服用托伐普坦后的治疗效果。方法回顾性分析19例难治性心力衰竭患者使用托伐普坦后,通过测量使用托伐普坦前后双下肢踝关节直径、体质量、尿量变化以及检测肌酐、血钠、血钾、脑钠肽(brain natriuretic peptide,BNP)浓度,评估托伐普坦的疗效。结果与治疗前比较,患者经过托伐普坦治疗后第1天尿量明显增多[(3 326.842±1 522.578)mL vs.(1 509.474±611.587)mL,P<0.01],且血浆BNP浓度明显下降[(1 945.421±762.133)pg/mL vs.(2 402.368±895.829)pg/mL,P<0.01],差异均具有统计学意义。治疗后第7天尿量增多,踝关节直径变小,体质量减轻,肌酐浓度下降,低钠血症得到纠正,血浆BNP浓度下降,与治疗前比较,差异均具有统计学意义(P<0.01);但血钾未见明显变化。结论托伐普坦有效改善难治性心力衰竭患者临床症状,维持水电解质平衡,有效改善肾功能。

Objectives To observe the efficacy of tolvaptan in patients with refractory heart failure. Methods A retrospective analysis of the clinical data of 19 patients with refractory heart failure was carried out. Lower limb ankle joint diameter, body weight, urine volume, creatinine, blood sodium, potassium and brain natriuretic peptide （BNP） of the patients were measured before and after receiving tolvaptan therapy to assess the efficacy. Results Compared with baseline, urine volume increased [（3 326.842±1 522.578） mL vs. （1 509.474±611.587） mL, P〈0.01] and plasma concentration of BNP decreased [ （ 1 945.421±762.133） pg/mL vs. （2 402.368±895.829） pg/mL, P〈0.01 ] one day after treatment. In 7 days of treatment, urine volume increased, lower limb ankle joint diameter, body weight, plasma concentrations of creatinine and BNP decreased, the differences were statistically significant compared with those of baseline（P〈0.01 ） ; but serum concentration of potassium did not significantly change. Conclusions Tolvaptan is effective for refractory heart failure patients. It can maintain water and electrolyte balance and improve renal function.