托伐普坦联合左西孟旦对老年顽固性心力衰竭患者的疗效分析

Effects of tolvaptan combined with levosimendan in treating elderly patients with intractable heart failure

目的探讨托伐普坦联合左西孟旦对老年顽固性心力衰竭(RHF)患者心功能及心率变异性(HRV)的影响。方法将125例老年RHF患者随机分为观察组63例和对照组62例。在常规治疗的基础上,对照组给予托伐普坦治疗,观察组在对照组基础上给予左西孟旦治疗。比较2组心功能[左室射血分数(LVEF)、每搏输出量(SV)、N端B型利钠肽原(NT-proBNP)],HRV[24h正常RR间期的标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值均方根(RMSSD)]以及氧化应激指标[丙二醛(MDA)、总抗氧化物(TAS)、过氧化脂质(LPO)]。结果治疗7 d后,观察组心功能指标均优于对照组,差异有统计学意义(P<0.05);观察组HRV指标均高于对照组,差异有统计学意义(P<0.05);观察组TAS高于对照组,MDA、LPO均低于对照组,差异有统计学意义(P<0.05)。结论托伐普坦联合左西孟旦可降低氧化应激程度和心肌损伤程度,改善老年RHF患者心功能和HRV。

Objective To investigate the effect of tolvaptan combined with levosimendan on cardiac function and heart rate variability (HRV) in elderly patients with refractory heart failure (RHF).Methods A total of 125 elderly patients with RHF were randomly divided into observation group (63 cases) and control group (62 cases). On the basis of conventional treatment,the control group was treated with tolvaptan,and the observation group was treated with levosimendan on the basis of the control group. Cardiac function [left ventricular ejection fraction (LVEF),stroke volume (SV),N-terminal B-type natriuretic peptide (NT-proBNP) ],HRV [standard deviation of 24 h normal RR interval (SDNN),standard deviation of average RR interval (SDANN),root mean square difference of adjacent RR intervals (RMSSD) ] and oxidative stress indicators [malondialdehyde (MDA),total antioxidant (TAS),lipid peroxide (LPO) ]were compared between the two groups. Results After 7 days of treatment,the cardiac function indexes of the observation group were significantly better than those in the control group (P < 0. 05);the HRV indexes in the observation group were significantly higher than those in the control group (P < 0. 05). TAS in the observation group was significantly higher than that in the control group (P < 0. 05),MDA and LPO were significantly lower than those in the control group (P < 0. 05). Conclusion Tolvaptan combined with levosimendan can reduce the degree of oxidative stress and myocardial injury,and improve cardiac function and HRV in elderly patients with RHF.