托伐普坦治疗高龄难治性心力衰竭患者的疗效观察

Observation of curative effect of tolvaptan in elderly patients with refractory heart failure

目的:观察托伐普坦在高龄难治性心力衰竭患者中的安全性及疗效。方法:对我院干部消化内科收治的24例常规治疗效果不佳的高龄难治性心力衰竭患者加用托伐普坦,观察患者心率(HR)、血压(BP)、呼吸频率(RR)、末梢血氧饱和度(SPO_2)、24 h尿量、体质量、每搏输出量(SV)、左室射血分数(LVEF)、血钠(Na)、血钾(K)、B型尿钠酸(BNP)、尿酸、体征及不良反应。结果:托伐普坦可明显改善难治性心衰患者的SV[(64.4±11.3)mL vs(59.8±8.6)mL,P<0.05]、LVEF[(48.6±9.1)%vs(36.2±6.5)%,P<0.05],增加24 h尿量[(2 034.8±492.2)mL vs(1 042.5±238.2)mL,P<0.01],提高血Na[(142.2±9.3)mmol·L^(-1) vs(127.9±7.6)mmol·L^(-1),P<0.05]、SPO_2[(97.4±2.5)%vs(89.2±9.6)%,P<0.05],减低HR[(92.7±12.2)次·min^(-1) vs(125.3±18.8)次·min^(-1),P<0.05]、RR[(20.2±2.6)次·min^(-1) vs(29.7±5.6)次·min^(-1),P<0.05]、BNP[(450.7±65.2)ng·L^(-1) vs(2 200.8±128.5)ng·mL^(-1),P<0.01],减轻肺部啰音、下肢水肿及体质量,对血K、血压、尿酸、血渗透压无影响。结论:对于常规治疗效果不佳的高龄难治性心衰患者,短期使用托伐普坦可进一步改善心功能及体征,密切监测可避免血钠快速升高等不良反应。

Objective:To observe the safety and efficacy of tolvaptan in elderly patients with refractory heart failure.Methods:Because of the poor effects of routine treatment,24cases of elderly patients with refractory heart failure were added with tolvaptan.Their heart rate(HR),blood pressure(BP),respiratory rate(RR),oxygen saturation of peripheral(SPO2),24-hour urine,body mass,stroke volume(SV),left ventricular ejection fraction(LVEF),serum sodium(Na),serum potassium(K),type B brain natriuretic peptide(BNP),uric acid,signs and side effects were observed.Results:Tolvaptan could significantly improve the SV[(64.4±11.3)mL vs(59.8±8.6)mL,P<0.05],LVEF[(48.6±9.1)%vs(36.2±6.5)%,P<0.05],increase24-hour urine[(2034.8±492.2)mLvs(1042.5±238.2)mL,P<0.01],Na[(142.2±9.3)mmol·L-1vs(127.9±7.6)mmol·L-1,P<0.05]and SPO2[(97.4±2.5)%vs(89.2±9.6)%,P<0.05],lower HR[(92.7±12.2)time·min-1vs(125.3±18.8)time·min-1,P<0.05],RR[(20.2±2.6)time·min-1vs(29.7±5.6)time·min-1,P<0.05]and BNP[(450.7±65.2)ng·L-1vs(2200.8±128.5)ng·mL-1,P<0.01],reduce the moist rales,lower limbedema and body mass,without affecting the blood potassium,blood pressure,uric acid and osmotic pressure.Conclusion:Shorttime tolvaptan application could improve the heart function of patients with refractory heart failure whose routine treatment werepoor,and avoid side effects like rapid increase of serum sodium and so on by close clinical monitoring.