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目的评估短期小剂量托伐普坦治疗失代偿心力衰竭合并低钠血症的有效性和安全性。方法筛选并回顾性分析2012年4月至2014年3月符合入选标准的患者资料,将患者分为托伐普坦组(15mg/d×7d)和标准治疗组(3%~4%高渗盐水×7d)。观察住院期间心力衰竭症状的改善和血清钠水平的升高情况以及口干、肌酐升高、神经系统症状等不良反应,统计出院后180d的心血管死亡率。结果共有37例患者入选,其中托伐普坦组16例,标准治疗组21例。两组的基线资料差异无统计学意义。在规范化治疗基础上,托伐普坦组治疗第7天血清钠升高程度、出院前体质量减轻幅度、血浆N末端脑钠肽前体(NT-proBNP)水平降低幅度、心功能恢复到Ⅱ级(NYHA分级)以上的比率均大于标准治疗组(P<0.05),住院期间日均呋塞米用量、肌酐升高幅度以及住院天数均小于标准治疗组(P<0.05),但两组180d心血管死亡率差异无统计学意义(P>0.05)。结论对于利尿剂抵抗的失代偿心力衰竭合并低钠血症的患者,短期小剂量托伐普坦可改善短期内失代偿性心力衰竭的症状,升高血清钠浓度,减轻利尿剂抵抗,并且不良反应较少、耐受性良好,但并不降低长期心血管死亡率。
Objective To evaluate the efficacy and safety of short-term, low-dose tolvaptan in the treatment of decompensated heart failure with hyponatremia. Methods Screening and retrospectively analyzed the data of patients who met the inclusion criteria from April 2012 to March 2014. The patients were divided into tolvaptan group (15mg / d × 7d) and standard treatment group (3% -4% Brine × 7d). Observe the symptoms of heart failure during hospitalization to improve and increase the level of serum sodium and dry mouth, creatinine, neurological symptoms and other adverse reactions, statistical cardiovascular mortality 180d after discharge. Results A total of 37 patients were enrolled, including 16 patients in the tolvaptan group and 21 in the standard treatment group. There was no significant difference in baseline data between the two groups. On the basis of standardized treatment, on the seventh day after treatment in the tolvaptan group, the level of serum sodium increased, the extent of weight loss before discharge from hospital, the level of plasma N-terminal pro brain natriuretic peptide (NT-proBNP) decreased and the cardiac function recovered to Ⅱ (NYHA class) were higher than those in the standard treatment group (P <0.05). The mean daily doses of furosemide during hospitalization, the increase in creatinine, and hospital stay were all less than those in the standard treatment group (P <0.05) There was no significant difference in cardiovascular mortality (P> 0.05). Conclusions For patients with diuretic-resistant decompensated heart failure with hyponatremia, short-term, low-dose tolvaptan may improve short-term symptoms of decompensated heart failure, increase serum sodium concentrations, reduce diuretic resistance, And less adverse reactions, well tolerated, but does not reduce long-term cardiovascular mortality.