托伐普坦联合呋塞米治疗老年慢性心力衰竭利尿剂抵抗患者的疗效观察

Therapeutic effect of low dose tolvaptan combined with furosemide in elderly patients with chronic heart failure and diuretic resistance

目的观察低剂量托伐普坦联合呋塞米治疗老年慢性心力衰竭(CHF)利尿剂抵抗患者的疗效。方法选择伴利尿剂抵抗的老年CHF患者85例,随机分为观察组(托伐普坦15mg/d口服联合呋塞米40mg/d静脉注射)43例与对照组42例。比较2组治疗前与治疗5d的日均尿量、左心室舒张末容积(LVEDV)变化。结果 2组患者治疗后尿量增加,LVEDV较治疗前降低(P<0.05);观察组尿量和LVEDV水平较对照组变化更显著[(2.89±0.87)L/d vs(2.43±0.49)L/d,P=0.01;(103.6±21.5)ml vs(116.7±24.3)ml,P=0.01)]。观察组治疗总有效率高于对照组(86.0%vs 71.4%,P=0.01)。结论联合应用低剂量托伐普坦和呋塞米能有效改善老年CHF患者的利尿剂抵抗,提高临床疗效,值得临床推荐。

Objective To observe the therapeutic effect of low dose tolvaptan combined with furosemide in ederly patients with CHF and diuretic resistance （DR）. Methods Eighty-five elderly patients with CHF and DR were divided into observation group （n=43） and control group （n= 42）. The patients in observation group were treated with cardiotonics and hypotensors plus oral tolvaptan （15 mg/d） combined with intravenous furosemide （40 mg/d）. The therapeutic effect of low dose tolvaptan combined with furosemide was assessed. Results The average urinary volume was larger,and the LVEDV was significantly lower in two groups after treatment than before treatment （P%G. 05）. The urinary volume was significantly larger while the LVEDV was signifi- cantly lower in observation group than in control group （2. 89±0.87 L/d vs 2.43±0.49 L/d,P= 0.01;103.6±21. 5 ml vs 116.7±24.3 ml,P=0.01）. The total effective rate was significantly higher in observation group than in control group （86.0% vs 71.4% ,P=0.01）. Conclusion Low dose tolvaptan combined with furosemide can effectively improve the DR and therapeutic effect in elderly CHF patients,and is thus worth popularization in clinical practice.