托伐普坦治疗慢性心力衰竭伴低钠血症的疗效及对患者心功能的影响

目的：观察托伐普坦治疗慢性心力衰竭(CHF)伴低钠血症的疗效，并探讨其对患者心功能的影响。方法选取2013年7月至2015年7月在我院住院治疗的80例CHF伴低钠血症患者，采用随机数表法分为观察组(常规治疗+托伐普坦)和对照组(常规治疗)，每组各40例，观察并比较治疗前后两组患者的疗效及心功能的变化。结果治疗后，观察组患者的治疗总有效率为87.5%(35/40)，明显高于对照组的75.0%(30/40)，差异有统计学意义(P<0.05)；观察组患者治疗后的24 h尿量[(2645.42±317.46) mL]、血钠[(142.24±1.63) mmol/L]、体质量[(59.55±4.35) kg]、BNP [(946.35±196.63) pg/L]、超声心动图参数[LVEF (50.64±4.32)%、LVEDd (40.36±4.52) mm、LVESd (34.86±3.75) mm]与其自身治疗前[24 h尿量(1451.21±235.35) mL、血钠(127.15±1.85) mmol/L、体质量(69.36±5.63) kg、BNP (2635.43±182.55) pg/L；超声心动图参数：LVEF (35.36±4.52)%、LVEDd (58.25±5.36) mm、LVESd (47.35±5.45) mm]比较均有所改善，差异有统计学意义(P<0.05)；观察组患者治疗后的24 h尿量、血钠、体质量、BNP、超声心动图参数(LVEF、LVEDd、LVESd)与对照组患者治疗后[24 h尿量(1326.63±265.52) mL、血钠(128.14±1.52) mmol/L、体质量(68.62±4.52) kg、BNP (2564.45±340.45) pg/L；超声心动图参数：LVEF (36.22±3.36)%、LVEDd (56.35±4.82) mm、LVESd (47.65±5.95) mm]相比亦均有显著改善，两组间差异具有统计学意义(P<0.05)；观察组患者的血钾、E/A比值在治疗前后无明显变化(P>0.05)，两组患者治疗后血钾、E/A比值相比差异无统计学意义(P>0.05)。治疗后1个月时随访，两组均无严重不良事件。结论托伐普坦治疗慢性心力衰竭伴低钠血症可提高临床疗效，改善心功能。

Efficacy and cardiac function of tolvaptan in treatment of hyponatremia in patients with chronic heart failure

Objective To observe the efficacy of tolvaptan in treatment of hyponatremia in patients with chron-ic heart failure (CHF), and to investigate the effect on cardiac function. Methods Eighty patients with CHF in our hos-pital from Jul. 2013 to Jul. 2015 were randomly divided into two groups. The control group was treated with convention-al treatment, while the treatment group was treated with tolvaptan plus conventional treatment. The total effective rate and cardiac function were compared between the two groups before and after treatment. Results After treatment, the to-tal effective rate in the treatment group was 87.5%, which was significantly higher than 75.0%in the control group (P<0.05). In the treatment group, the 24 h urine volume [(2 645.42 ± 317.46) mL], serum sodium [(142.24 ± 1.63) mmol/L], body weight [(59.55 ± 4.35) kg], BNP [(946.35 ± 196.63) pg/L], echocardiography parameters [LVEF (50.64 ± 4.32)%, LVEDd (40.36±4.52) mm, LVESd (34.86±3.75) mm] of patients after treatment were improved (P<0.05) compared with before treatment [(1 451.21 ± 235.35) mL, (127.15 ± 1.85) mmol/L, (69.36 ± 5.63) kg, (2 635.43 ± 182.55) pg/L, (35.36 ± 4.52)%, (58.25 ± 5.36) mm, (47.35 ± 5.45) mm, respectively]. After treatment, the above indexes in the treatment group were significantly improved compared with those in the control group [(1 326.63 ± 265.52) mL, (128.14 ± 1.52) mmol/L, (68.62±4.52) kg, (2 564.45±340.45) pg/L, (36.22±3.36)%, (56.35±4.82) mm, (47.65±5.95) mm], P<0.05. Potassium, E/A ratio in the treatment group showed no significant change before and after treatment (P>0.05), and potassium, E/A ratio after treatment had no significant difference between the two groups (P>0.05). There was no adverse event during the fol-low-up of one month after treatment. Conclusion Application of tolvaptan in treatment of CHF with hyponatremia can improve the clinical effective efficacy and cardiac function.