托伐普坦联合呋塞米治疗慢性心肾综合征利尿剂抵抗患者的疗效观察

Therapeutic Effects of Tolvaptan Combined with Furosemid in the Treatment of Chronic Cardiorenal Syndrome Patients with Diuretic Resistance

目的:观察低剂量托伐普坦联合呋塞米治疗慢性心肾综合征伴利尿剂抵抗患者的临床疗效。方法:选择伴利尿剂抵抗的慢性心肾综合征患者71例,随机分为观察组36例和对照组35例。观察组应用托伐普坦15~30 mg/d口服联合呋塞米40 mg每日两次静脉注射;对照组应用呋塞米400 mg/d微量泵持续静脉输注。监测比较两组治疗前与治疗96 h的日尿量变化及临床疗效;记录比较两组高钠血症、肝肾功能损伤等不良反应的发生情况。结果:治疗后两组患者尿量较治疗前均增多(P<0.001),观察组患者尿量持续增加,至72 h达高峰,此后维持相近水平;对照组患者尿量48 h达高峰,此后维持相似水平;两组患者尿量比较显示观察组48 h、72 h和96 h尿量较对照组增多(P<0.01)。观察组疗效优于对照组(P=0.026);两组间总不良反应发生率无统计学差异(P>0.05)。结论:联合应用低剂量托伐普坦与呋塞米能有效改善慢性心肾综合征患者的利尿剂抵抗,提高临床疗效且未增加不良反应。

Objective:To observe the therapeutic effects of low dosage tolvaptan combined with furosemide in chronic cardiorenal syndrome(CRS-2)patients with diuretic resistance(DR).Methods:71 CRS-2 patients with DR were randomly divided into observation group(36 cases)and control group after treatment(35 cases).The observation group treated with 15-30 mg tolvaptan combined with 40 mg furosemide injection twice a day,while the control group treated with 400 mg furosemide through continuously venous transfusion.The urinary volume before and after the treatments and the therapeutic effects of the two groups were recorded and compared.Results:The daily urinary volumes of the two groups increased after treatments(P<0.001).The peak urinary volumes of the observation group was at the 72 hour after treatment and the control group was at the 48 hour after treatment.There were statistical difference between the urinary volume of the two groups(P<0.01).The observation group had better clinical effects than the control group(P=0.026).While the total adverse reactions rate showed no statistical difference between the two groups(P>0.05).Conclusion:Low dosage tolvaptan combined with furosemide could significantly alleviate the diuretic resistance and improve the clinical effects in the chronic cardiorenal syndrome patients,and without increasing adverse reactions.