托伐普坦治疗慢性肺源性心脏病失代偿期下肢水肿伴低钠血症患者的短期疗效观察

Short-term efficacy of tolvaptan in treatment of lower extremity edema with hyponatremia in patients with decompensated chronic pulmonary heart disease

目的观察托伐普坦在慢性肺源性心脏病失代偿期下肢水肿伴低钠血症患者中的短期疗效及安全性。方法选取徐州医科大学第二附属医院2017年1月至2018年12月收治的慢性阻塞性肺疾病所致慢性肺源性心脏病失代偿期60例患者;将60例肺心病失代偿期下肢水肿伴低钠血症患者经积极抗感染、化痰、解痉止喘、氧疗等治疗后,按随机数字表随机分为治疗组、对照组各30例。对照组给予螺内酯20 mg口服2/d+呋塞米20 mg口服1/d+10%氯化钠注射液10 mL3/d,连续治疗1周,且血钠恢复>135 mmol/L时即停用浓钠治疗;治疗组给予托伐普坦15 mg口服1/d连续治疗服用1周。两组患者治疗前后测量指标:超声多普勒测定肺动脉压力及右室+右室流出道内径,门静脉内径;下肢水肿体征变化;血清脑钠肽前体(NT-proBNP)、治疗前后每日24 h尿量记录,体重指数、肾功能肌酐及尿素氮水平、肝脏转氨酶测定,血清钠水平、血浆渗透压测定。利尿药物不良反应包括口干、口渴情况记录。结果与治疗前相比,两组患者的下肢水肿均有所改善;超声多普勒测定肺动脉压力、右室内径、右室流出道内径、门静脉内径有减小;血清NT-proBNP,体重指数下降、两组患者尿量均有增加,血清钠水平均有增加,(均P<0.05)。与对照组比较,治疗组患者的下肢水肿、肺动脉压力、右室内径、右室流出道内径、门静脉内径变化,血清NT-proBNP,体重指数下降情况等方面较明显,差异有统计学意义(均P<0.05)。治疗前后两组患者肝脏转氨酶水平,肾功能肌酐、尿素氮水平、血浆渗透压差异无统计学意义(均P>0.05)。两组患者口干、口渴发生率差异无统计学意义(P>0.05)。结论托伐普坦短期内应用可有效改善慢性肺源性心脏病失代偿期的右心功能,升高血钠水平及降低NT-proBNP水平,且无明显严重不良反应。

Objective To observe the short-term efficacy and safety of tolvaptan for lower extremity edema and hyponatremia in patients with decompensated chronic pulmonary heart disease(CPHD).Methods Totally 60 decompensated CHPD patients with lower extremity edema and hyponatremia after anti-infection,dissipating phlegm,spasmolysis and oxygen therapy were selected from January 2017 to December 2018 to randomly divided into treatment group and control group according to random number table.The patients in control group had received spironolactone 20 mg orally 2/day+furosemide 20 mg orally 1/day+10%sodium chloride 10 mL orally 3/day for 1 week,and 10%sodium chloride was given until their blood sodium>135mmol/L.Meanwhile,patients in treatment group were given tolvaptan 15 mg orally 1/day for 1 week.We compared the following measurements in these two groups of patients before and after treatment:pulmonary artery pressure,right ventricular+the inner diameter of right ventricular outflow tract and portal vein diameter by ultrasound doppler,together with the lower extremity edema and changes in gastrointestinal symptoms like abdominal distension etc.,and serum brain natriuretic peptide precursor(NT-proBNP),24h daily urine volume record for seven days treatment,body mass index,renal creatinine and urea nitrogen levels,liver transaminase determi-nation,serum sodium level and plasma osmolality.Adverse reactions to diuretic drugs including dry mouth and thirst were recorded as well.Results The symptoms of right ventricular dysfunction including lower extremity edema and abdominal distension were improved in both groups before treatment.Ultrasound Doppler measurement of pulmonary artery pressure,right ventricular diameter,right ventricular outflow tract inner diameter and portal vein diameter were reduced.In the meantime,serum NT-proBNP and body mass index decreased with urine output and serum sodium levels increased in both groups(P<0.05).Compared with the control group,patients with right ventricular dysfunction in the treatment group included lower extremity edema,improvement in abdominal distension,pulmonary artery pressure,right ventricular diameter,right ventricular outflow tract inner diameter,portal vein diameter change,serum NT-proBNP and body mass index decrease had statistically significance(P<0.05).There were no significant differences in liver transaminase levels,renal creatinine,urea nitrogen levels,and plasma osmotic pressure between the two groups before and after treatment(allP>0.05).There was no significant difference in the incidence of dry mouth and thirst between the two groups(P>0.05).Conclusion The short-term application of tolvaptan can effectively improve the right heart function of decompensated chronic pulmonary heart disease,increase blood sodium level and reduce NT-proBNP level,and no serious adverse reactions.