托伐普坦对老年收缩性心力衰竭患者的疗效

摘要

Objective To observe the curative effect of tolvaptan in elderly patients with systolic heart failure (SHF).Methods The patients with SHF from grade II to IV (n=58, male 33, female 25, aged from 64 to 83 and average age=68.3±3.7) were chosen continuously from Jan. 2013 to Jan. 2014, and then randomly divided into control group (n=28) and tolvaptan group (n=30). Besides of relevant treatment, control group was given intravenous injection of furosemide once a day, and tolvaptan group was orally given tolvaptan once a day for 5 d. The changes of laboratory indexes [including urine volume, blood sodium, blood potassium and serum creatinine (SCr)] and cardiac echocardiogram indexes [ratio of early-diastolic fast filling velocity and late-diastolic fast filling velocity (E/A), left ventricular end-diastolic inner diameter (LVEDd) and left ventricular ejection fraction (LVEF)], and grade of New York Heart Function Assessment (NYHA) were respectively detected in 2 groups.Results After treatment for 5 d, urine volume and blood sodium level increased significantly in tolvaptan group compared with control group (allP<0.05). In tolvaptan group, E/A was (1.38±0.11) and LVEF was (57.1±2.9)%, which were significantly higher than those in control group [1.20±0.09, (49.8±4.7)%], and LVEDd was lower in tolvaptan group than that in control group [(48.1 ±4.5) mm vs. (54.1±4.5) mm, allP<0.05]. The percentage of patients with NYHA grade II was significantly higher in tolvaptan group than that in control group (80.0%vs. 42.9%) after treatment (P<0.05).Conclusion Tolvaptan can relieve the symptoms of SHF in elderly patients with higher clinical application value.%目的：观察托伐普坦对老年收缩性心力衰竭患者的疗效。方法连续入选2013年1月~2014年1月于连云港市第二人民医院老年医学科住院治疗的58例纽约心功能Ⅱ～IV级收缩性心力衰竭患者，其中男性33例，女性25例，年龄64～83（68.3±3.7）岁。随机分为对照组（n=28例）和托伐普坦组（n=30）。在相应治疗基础上，对照组给予静脉推注呋塞米，1/日；托伐普坦组口服托伐普坦，1/日，连续治疗5 d。用药5 d后，分别检测两组患者实验室指标：包括尿量、血钠、血钾、血肌酐；心脏超声指标：包括舒张早期充盈峰速度/舒张晚期充盈峰速度（E/A比值）、左室舒张末期内径（LVEDD）和左室射血分数（LVEF），以及两组纽约心功能（NYHA）分级变化。结果治疗5 d后，与对照组治疗后比较，托伐普坦组患者的尿量、血钠浓度明显升高，差异有统计学意义（P均＜0.05）。托伐普坦组心脏彩超指标E/A比值和LVEF分别为（1.38±0.11）、（57.1±2.9）%，明显高于对照组的（1.20±0.09）、（49.8±4.7）%，LVEDD值低于对照组[（48.1±4.5）mmvs.（54.1±4.5）mm]，差异有统计学意义（P均＜0.05）。托伐普坦组治疗后NYHA II级比例明显高于对照组（80.0% vs.42.9%），差异有统计学意义（P＜0.05）。结论托伐普坦能有效改善老年收缩性心力衰竭患者症状，具有较高的临床应用价值。