托伐普坦在重症心力衰竭合并低钠血症患者中的应用效果分析

The effect of Tolvaptan in hyponatremia patients with severe heart failure

目的探究托伐普坦在重症心力衰竭合并低钠血症患者中的临床价值及效果。方法选择2013年2月~2015年2月上海市同仁医院急诊科明确诊断为重症心力衰竭合并低钠血症患者共144例。其中82例定义为药物组，服用托伐普坦+常规治疗；62例定义为对照组，仅采用常规治疗。比较治疗前以及治疗3个月后明尼苏达州心衰生活质量问卷（MLHFQ）评分、超声心动图，超声评估指标包括左室射血分数（LVEF）、左室短轴缩短率（LVSF）、左室舒张末内径（LVDd）及收缩末内径（LVSd）。评估治疗3个月后治疗效果。比较治疗前以及治疗24h后N末端脑钠肽前体（NT－proBNP）及超敏C-反应蛋白（hs－CRP）、血钠、尿量、重量等变化，以及不良反应。结果与对照组比较，药物组患者血钠经治疗后明显上升，NT-proBNP及hs-CRP的含量则下降明显，差异具有统计学意义（P均＜0.05）。药物组患者的心脏功能得到明显改善，LVEF等明显高于对照组，而LVDd、LVSd均明显降低，差异具有统计学意义（P均＜0.05）。重症心力衰竭患者经托伐普坦药物治疗后，效果明显好于对照组，总有效率对比为93.90%vs.80.65%，差异具有统计学意义（P＜0.01）。药物组患者的MLHFQ评分改善程度较对照组好，下降程度高，差异具有统计学意义（P＜0.05），且药物组尚无出现明显肝肾功能改变等不良反应。结论托伐普坦在治疗重症心力衰竭合并低钠血症患者中具有显著优势，能够有效逆转心脏功能，且不增加不良反应，纠正低钠血症。

Objective To investigate effect of Tolvaptan in hyponatremia patients with severe heart failure.Methods 144 patients clearly diagnosed as severe heart failure with hyponatremia were selected. 82 cases were defined the treatment group with Tolvaptan plus regular treatment; 62 cases were defined as control group with only regular treatment. Minnesota Living With Heart Failure Questionnaire (MLHFQ) scores, echocardiography,ultrasound assessment indicators, including left ventricular ejection fraction (LVEF), Left Ventricular Systolic Function (LVSF), left ventricular end diastolic diameter (LVDD), left ventricular systolic dysfunction (LVSD),N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP),sodium, urine output, weight, and adverse events were measured before and at 3 months after treatment. Results Blood sodium of patients in the treatment group significantly increased, and hs-CRP, NT-proBNP decreased significantly (P<0.05). As to patients in the treatment group, the cardiac function was improved significantly, the difference has statistical significance (P<0.05). Curative effect was better in treatment group than control group (93.90% vs. 80.65%, P<0.01). The MLHFQ score of treatment group improved better than that of control group (P<0.05). No adverse event of hepatic and renal function was observed. Conclusion Tolvaptan can effectively reverse the cardiac function, and correct hyponatremia with no increasing adverse reactions.