托伐普坦片联合托拉塞米片治疗老年心力衰竭的临床效果及对神经内分泌因子的影响

Clinical effect of tolvaptan tablets combined with torasemide tablets in the treatment of elderly heart failure and its influence on neuroendocrine factors

目的 观察托伐普坦片联合托拉塞米片治疗老年心力衰竭的临床效果及对神经内分泌因子的影响。方法 选取2019年1月—10月湖南省株洲市二医院收治的老年心力衰竭患者82例为研究对象,按照样本抽样采集法随机分为试验组和对照组,每组41例。对照组患者采用托拉塞米片治疗,试验组患者则在对照组基础上加用托伐普坦片治疗,2组患者均治疗2个月。比较2组患者治疗效果,治疗前后肺功能指标[第1秒用力呼气容积预计值(FEV_(1)%)、最大呼气流量(PEF)]、心功能指标[左室射血分数(LVEF)、左室收缩末期内径(LVESD)、E/A及二尖瓣与室间隔的距离(EPSS)]、神经内分泌因子[血钠离子(Na^(+))、钾离子(K^(+))、丝氨酸(Ser)、尿素氮(BUN)、肾素活性(PRA)、醛固酮(ALD)、B型脑钠肽(BNP)及神经营养因子-3(Cal-3)]变化。结果 试验组患者总有效率为92.68%,高于对照组的73.17%(χ^(2)=5.513,P=0.019);治疗2个月后,2组患者FEV_(1)%、PEF均较治疗前增加,且试验组高于对照组(P<0.05或P<0.01);2组患者LVEF、E/A较治疗前升高,LVESD、EPSS较治疗前缩小,且试验组升高或缩小程度大于对照组(P均<0.01);试验组患者治疗后血Na^(+)水平高于对照组,Ser、BUN、PRA、ALD、BNP和Cal-3水平均低于对照组(P<0.01),2组治疗前后K^(+)水平比较差异无统计学意义(P>0.05)。结论 托伐普坦片联合托拉塞米片治疗老年心力衰竭的效果显著,可改善患者肺功能指标、心功能指标,并可调节神经内分泌因子水平,值得临床推广应用。

Objective To observe the clinical effect of tolvaptan tablets combined with torasemide tablets in the treatment of elderly heart failure and its influence on neuroendocrine factors.Methods Eighty-two elderly patients with heart failure admitted to the Zhuzhou Second Hospital from January to October 2019 were randomly divided into experimental group and control group according to sample sampling method,with 41 patients in each group.The patients in the control group were treated with torasemide tablets,while the patients in the experimental group were treated with tolvaptan tablets on the basis of the control group.The patients in both groups were treated for 2 months.The therapeutic effects of the two groups were compared,and the changes of pulmonary function index(FEV_(1)%,PEF),cardiac function index(LVEF,LVESD,E/A,EPSS)and neuroendocrine factor(Na^(+),K^(+),Ser,BUN,PRA,ALD,BNP,Cal-3)before and after treatment were compared.Results The total effective rate in the experimental group was 92.68%,higher than 73.17%in the control group(χ^(2)=5.513,P=0.019);After 2 months of treatment,FEV_(1)%and PEF in both groups increased compared with those before treatment,and the experimental group was higher than that in the control group(P<0.05 or P<0.01);LVEF and E/A in the two groups were higher than before treatment,LVESD and EPSS were smaller than before treatment,and the degree of increase or decrease in the experimental group was greater than that in the control group(all P<0.01);After 2 months of treatment,the level of blood Na^(+)in the experimental group was higher than that in the control group,and the levels of Ser,BUN,PRA,ALD,BNP and Cal-3 were lower than those in the control group(P<0.01),there was no significant difference in K^(+)level between the two groups before and after treatment(P>0.05).Conclusion Tolvaptan tablets combined with torasemide tablets have significant effect in the treatment of elderly heart failure.It can improve the pulmonary function index and cardiac function index,and regulate the level of neuroendocrine factors,which is worthy of clinical application.