托伐普坦治疗老年难治性心力衰竭的临床效果

Clinical effect of tolvaptan in the treatment of elderly patients with refractory heart failure

目的探讨托伐普坦治疗老年难治性心力衰竭的临床效果。方法选取2019年5月至2020年7月我院心血管内科收治的300例老年难治性心力衰竭患者作为研究对象,按照随机数字表法将其分为对照组和观察组,每组150例。对照组给予呋塞米、重组人脑利钠肽治疗,观察组在对照组基础上给予托伐普坦治疗。比较两组的临床疗效、心功能指标、24 h尿量、生命体征指标、神经内分泌因子指标、不良反应发生情况。结果观察组的治疗总有效率为97.33%,高于对照组的90.00%,差异具有统计学意义(P<0.05)。治疗后,观察组的6MWD长于对照组,LVEF高于对照组,LVEDD、LVESD低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的24 h尿量多于对照组,SBP、DBP高于对照组,HR、RR低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的Scr、BUN、NT-proBNP、Renin、ALD水平低于对照组,差异具有统计学意义(P<0.05)。两组的不良反应总发生率无显著差异(P>0.05)。结论托伐普坦治疗老年难治性心力衰竭的效果显著,可有效改善患者的心功能,促使尿量和生命体征恢复,抑制神经内分泌因子释放,且不良反应较少,安全性良好。

Objective To investigate the clinical effect of tolvaptan in the treatment of elderly patients with refractory heart failure.Methods From May 2019 to July 2020,300 elderly patients with refractory heart failure admitted in the internal medicine-cardiovascular department of our hospital were selected as the research objects,and the patients were divided into control group and observation group according to random number table method,with 150 cases in each group.The control group was treated with furosemide and recombinant human brain natriuretic peptide,and the observation group was treated with tolvaptan on the basis of the control group.The clinical efficacy,cardiac function indexes,24 h urine volume,vital signs indexes,neuroendocrine factors indexes and adverse reactions were compared between the two groups.Results The total effective rate of treatment in the observation group was 97.33%,which was higher than 90.00%in the control group,and the difference was statistically significant(P<0.05).After treatment,6MWD in the observation group was longer than that in the control group,LVEF was higher than that in the control group,LVEDD and LVESD were lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the 24 h urine volume in the observation group was more than that in the control group,SBP and DBP were higher than those in the control group,HR and RR were lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of Scr,BUN,NT-proBNP,renin and ALD in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The effect of tolvaptan in the treatment of elderly patients with refractory heart failure is significant,which can effectively improve the heart function of patients,promote the recovery of urine volume and vital signs,inhibit the release of neuroendocrine factors,with less adverse reactions and good safety.