托伐普坦对肝硬化腹水并发低钠血症患者Na^+调控作用的影响

Effect of the regulation of Tolvaptan for Na^+ in patients of liver cirrhosis ascites complicated with hyponatremia

目的观察托伐普坦对肝硬化腹水并发低钠血症患者Na^+的调控作用。方法选取2013年1月~2016年1月厦门大学附属第一医院收治的肝硬化腹水并发低钠血症患者110例。随机分成2组,A组55例使用托伐普坦治疗,不限液体入量,限制体内钠盐摄入;B组55例使用常规治疗,控制其每天液体摄入量在1~1.5 L,并视每位患者的具体情况而定适时补充钠盐和白蛋白以及利用利尿剂。治疗周期为8 d,比较2患者治疗前后体内的血钠值、血钾浓度和尿量,记录2组患者在治疗过程中的不良反应。结果治疗后第8天,A、B组患者血钠值均显著高于治疗前(P<0.05);A、B组患者尿量分别为(3 124.2±689.2)ml和(1 722.3±625.7)ml,与治疗前(1 253.6±504.4)ml和(1 277.5±647.3)ml相比,差异有统计学(P<0.05)。且A组患者治疗过程中伴有口干、渴感等不良反应,B组患者不良反应不明显。结论托伐普坦对肝硬化腹水并发低钠血症患者的Na^+有明显调控作用,和常规治疗方式相比作用显著。

Objective To observe the regulatory role of tolvaptan for Na-＋ in patients with cirrhotic ascites complicated with hyponatremia.Methods 110 cases from January 2013 to January 2016 in the first affiliated hospital of xiamen university treatment for liver with cirrhosis ascites complicated with hyponatremia were collected and randomly divided into two groups,55 cases in group A using tolvaptan treatment,55 cases in group B using conventional treatment. Group A and B comparison experiment was carried out,group Awith oral tolvaptan tome,no liquid intake,limit sodium salt treatment,group B patients control their daily fluid intake in 1 - 1. 5 L,and depending on the specific situation of each patient timely added sodium salt and albumin as well as the use of diuretics. Treatment period of 8 days,comparing two groups of patients serum sodium and potassium concentration in the body and urine output before and after treatment. Records of adverse reactions in two groups of patients in the treatment process. Results The eighth day after treatment,group A and group B patients serum sodium values were 138. 44 ± 7. 02 mmol/L and 131. 26 ± 6. 06 mmol/L,compared with before treatment（130. 54 ± 5. 24） mmol/L and（129. 44 ± 5. 15） mmol/L（P 〈0. 05）; the urinary production of group A and group B patients were（3 124. 2 ±689. 2） ml and（1 722. 3 ± 625. 7） ml,compared with before treatment（1 253. 6 ± 504. 4） ml and（1 277. 5 ± 647. 3） ml,with significant difference（P 〈0. 05）. Conclusion Tolvaptan for cirrhotic ascites complicated with hyponatremia in patients with Na-＋ has obvious control effect,has significant effect compared with conventional treatment.