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目的评价托伐普坦治疗肝硬化顽固性腹水合并低钠血症的疗效和安全性。方法 62例肝硬化顽固性腹水合并低钠血症患者随机分为托伐普坦组和常规利尿剂组。分别每日服用15 mg托伐普坦片或常规利尿剂。观察点为治疗前1天(基线)、治疗第4天及治疗第7天,主要观察项目包括血清钠、氯、钾、CO2CP等生化指标,尿量、腹围、体质量以及ALT、TBIL等肝功指标,BUN、Cr、e GFR等肾功指标。结果治疗第4、7天,托伐普坦组血钠值分别为(132.8±6.3)、(133.3±6.9)mmol/L,显著优于常规利尿剂组(128.8±6.0)、(129.4±6.6)mmol/L(P<0.05)。托伐普坦组尿量增加和体质量、腹围下降均优于常规利尿剂组(P<0.05)。两组患者治疗前后肝功、肾功、血压和心率变化差异无统计学意义(P>0.05)。结论托伐普坦可有效纠正肝硬化顽固性腹水患者低钠血症,增加尿量,改善液体平衡,对肝肾功能无不良影响。
Objective To evaluate the efficacy and safety of tolvaptan in the treatment of refractory cirrhosis with hyponatremia. Methods Sixty-two patients with cirrhosis with refractory ascites and hyponatremia were randomized into the tolvaptan group and the routine diuretic group. Take daily 15 mg of tolvaptan or conventional diuretic. The observation points were one day before treatment (baseline), the fourth day of treatment and the seventh day of treatment. The main observation items included biochemical indexes of serum sodium, chlorine, potassium and CO2CP, urine output, abdominal circumference, body weight and ALT, TBIL, etc. Liver function indicators, BUN, Cr, e GFR and other indicators of renal function. Results On the 4th and 7th day of treatment, the blood sodium levels in the tollipodine group were (132.8 ± 6.3) and (133.3 ± 6.9) mmol / L, respectively, which were significantly better than those in the routine diuretic group (128.8 ± 6.0) and (129.4 ± 6.6) ) mmol / L (P <0.05). In tolvaptan group, the increase of urinary output, body mass and abdominal circumference decreased more than those of routine diuretic group (P <0.05). There was no significant difference in liver function, renal function, blood pressure and heart rate between the two groups before and after treatment (P> 0.05). Conclusion Tolvaptan can effectively correct hyponatremia in patients with cirrhosis and refractory ascites, increase urine output, improve fluid balance and have no adverse effects on liver and kidney function.