托伐普坦治疗顽固性心力衰竭中严重利尿剂抵抗疗效观察

目的：观察托伐普坦治疗顽固性心力衰竭中严重利尿剂抵抗的疗效。方法对经大剂量利尿剂（速尿大于200mg/d）治疗效果不佳，且不伴有严重低钠血症的顽固性心力衰竭患者3例给予托伐普坦15mg/d治疗，观察治疗后体重、尿量、血肌酐、肝功能、电解质的变化。结果治疗1d后体重平均减轻3.16kg；尿量平均增加5540ml；治疗3~5d后血肌酐指标2例降至正常，另外1例较前有轻度改善；肝功能、电解质无明显变化。结论托伐普坦能有效治疗严重利尿剂抵抗，有助于心肾功能改善，疗效较好，无明显不良反应发生。

Observation of the effect of Tolvaptan on severe diuretic resistance in refractory heart failure

Objective To observe the clinical effect of Tolvaptan on severe diuretic resistance in refractory heart failure. Methods 3 cases of patient with refractory heart failure and without severe hyponatremia had no good curative effect after large dose of diuretics （the dose of furosemide was more than 200mg/d） therapy, were treated with Tolvaptan （15mg/d）. The changes of body weight, urine volume, serum creatinine, liver function, electrolytes were observed after treatment. Results One day after treatment,body weight reduced 3.16kg on average, urine output reached 5 540ml on average. In the 3~5 days after treatment, creatine level dropped to normal in 2 cases, another case showed a slight decreasing tendency. Hepatic function and electrolyte had no obvious change. Conclusion Tolvaptan is effective in treating severe diuretic resistance,and helpful to improve car-diac and renal function,the curative effect is good,and has no significant adverse events.