托伐普坦治疗老年心力衰竭的回顾性研究

The effects of tolvaptan on elderly patients with heart failure: a retrospective study

目的:回顾性分析托伐普坦治疗老年心衰的现状,为临床合理应用利尿剂提供指导。方法:收集2015年7月—2018年6月入院并开始服用托伐普坦的老年心力衰竭患者病例资料共63例,分析诊疗情况并行电话随访。结果:63位患者服用托伐普坦已持续(21.2±16.5)个月(最长41个月),最常用剂量为7.5 mg·d-1(71.4%);基础心脏疾病主要为缺血性心肌病(39.7%)和老年退行性心脏病(34.9%),心功能分级主要为NYHAⅢ级(57.1%)和Ⅳ级(30.2%);启用托伐普坦的原因分别为难治性心衰(34.9%)、合并低钠血症(25.4%)、合并肾功能不全(23.8%)、合并痛风或高尿酸血症(15.9%);托伐普坦治疗后日均尿量增加,NT-proBNP值下降,心脏射血分数提高,差异较治疗前均有显著性(P<0.05);相关药物不良反应主要为口干(11.1%)和血钠升高(4.8%)。结论:托伐普坦可有效利尿和改善心功能,对肾功能无不良影响,老年患者长期服用安全性好。

OBJECTIVE To retrospectively investigate the current treatment of tovaptan in elderly patients with heart failure,and provide guidance for the rational use of diuretics.METHODS A total of 63 elderly patients with heart failure who were admitted to hospital from July 2015 to June 2018 and started to take tolvaptan were collected.Their diagnosis and treatment were analyzed and telephone follow-up was conducted.RESULTS Sixty-three patients had been treated with tolvaptan for(21.2±16.5)months(up to 41 months),with the most common dose being 7.5 mg·d-1(71.4%);the underlying cardiac diseases were mainly ischemic cardiomyopathy(39.7%)and degenerative heart disease in the elderly(34.9%),and the cardiac function classification was mainly NYHA classⅢ(57.1%)and IV(30.2%);the reasons for starting tolvaptan were refractory heart failure(34.9%),hyponatremia(25.4%),renal insufficiency(23.8%),and gout or hyperuricemia(15.9%);the average daily urine volume increased,NT-proBNP value decreased,and cardiac ejection fraction increased after tolvaptan treatment,with a significant difference compared with that before treatment(P<0.05);the adverse drug reactions were mainly dry mouth(11.1%)and blood sodium increase(4.8%).CONCLUSION Tolvaptan is an effective diuretic and can improve cardiac function without adverse effect on renal function.It can be safely prescribed to elderly patients for years.