托伐普坦联合呋塞米治疗急性左心衰竭的效果观察

Effect of tolvaptan combined with furosemide in the treatment of acute left heart failure

目的:探讨托伐普坦联合呋塞米治疗急性左心衰竭(ALHF)的效果。方法:将2017年6月至2018年12月收治的88例ALHF患者随机分为对照组和观察组,每组44例。对照组先静脉注射呋塞米20~40mg,继以静脉滴注呋塞米5~40mg/h(总剂量在起初6h≤80mg,起初24h≤200mg),观察组在对照组的基础上给予托伐普坦15mg/d口服。2组疗程均为7d。对比2组的容量驱除、电解质、肾功能和疗效。结果:观察组治疗后体重下降值和日平均尿量均明显多于对照组(P<0.05)。与对照组相比,观察组的血钠浓度明显升高,而尿素氮和血肌酐的浓度则明显降低(P<0.05)。观察组的疗效优于对照组(P<0.05)。2组心脏射血分数上升率和血钾浓度差异无统计学意义(P>0.05)。结论:托伐普坦联合呋塞米治疗ALHF在容量驱除、保护肾功能和提高疗效方面均效果明显。

Objective: To investigate the effect of tolvaptan combined with furosemide in the treatment of acute left heart failure (ALHF). Methods: A total of 88 patients with ALHF from Jun 2017 to Dec 2018 were randomly divided into observation group and control group, 44 cases in each group. The control group was given furosemide 20-40 mg at first, followed by intravenous drip of furosemide 5-40 mg/h (the total dose was 80 mg in the first 6 h and ≤200 mg in the first 24 h). The observation group was given tolvaptan 15 mg/d orally on the basis of the control group. Both groups were treated for 7 days. The volume exclusion , electrolyte, renal function and curative effect were compared between the two groups. Results: The weight loss and average daily urine volume in the observation group were significantly higher than those in the control group (P<0.05). Compared with the control group, the concentration of serum sodium in the observation group was significantly higher, while the concentration of urea nitrogen and creatinine was significantly lower (P<0.05). The curative effect of the observation group was better than that of the control group (P< 0.05). There was no significant difference in the increase rate of ejection fraction and serum potassium concentration between the two groups (P>0.05). Conclusion: Tolvaptan combined with furosemide in the treatment of ALHF has obvious effects in the volume exclusion, protection of renal function and improvement of curative effect.