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小剂量托伐普坦对超高龄慢性心力衰竭患者的疗效 及安全性评价

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摘要:

目的 探讨小剂量托伐普坦片治疗超高龄慢性心力衰竭患者的临床疗效及安全性。方法 选
择2017年2月至2018年11月于解放军总医院第七医学中心干四科住院的12例超高龄慢性心力衰竭患者,
在常规治疗基础上加用小剂量托伐普坦片(7.5 mg/d)治疗,观察治疗第3 d、第7 d及第30 d时所有患者
的血钠、血钾、肌酐、尿素氮、谷丙转氨酶、谷草转氨酶、尿酸、脑钠肽、24 h尿量、血压、心率的变
化和不良反应情况。结果 治疗后患者血钠水平较治疗前有所上升,BNP逐渐下降,尿量也逐渐增多,且
在治疗后30 d内尿量仍可持续高于治疗前水平。治疗后患者的血压、心率与治疗前相比均有下降,差异
有统计学意义(P<0.05)。所有患者的血钾水平、肝功能(谷丙转氨酶、谷草转氨酶)、肾功能(肌
酐、尿素氮、尿酸)与治疗前相比均无显著变化(P>0.05)。在观察期间有1例患者出现口干症状,1例
患者有尿频表现。结论 小剂量托伐普坦片在治疗超高龄慢性心力衰竭患者时,可升高血钠水平、增加
尿量,改善心功能,稳定血压、心率,且无明显不良反应,具有较好的临床疗效及安全性。

Abstract:

Objective To discuss the curative effect and safety of low-dose tolvaptan in super-elderly
patients with chronic heart failure (CHF). Methods The super-elderly patients with CHF (n=12) were chosen from
the Forth Department of Geriatrics in Seventh Medical Center of Chinese PLA General Hospital from Feb. 2017 to
Nov. 2018, and they were treated with low-dose tolvaptan (7.5 mg/d) on the base of routine treatment. The changes
of serum sodium (Na), serum potassium (K), creatinine (Cr), blood urea nitrogen (BUN), alanine aminotransferase
(ALT), aspertate aminotransferase (AST), uric acid (UA), B-type natriuretic peptide (BNP), 24-h urinary volume,
blood pressure (BP) and heart rate (HR) and incidence of adverse reactions were observed on the 3rd d, 7th d and
30th d. Results After treatment, Na level increased, BNP decreased gradually and urinary volume increased
gradually, and urinary volume kept above pre-treatment level after 30 d in all patients. BP and HR decreased
after treatment compared with those before treatment in all patients (P<0.05). The level of K, liver function (ALT,
AST) and kidney function (Cr, BUN, UA) had no significant changes after treatment compared with before (P>0.05).
There was 1 patients with thirst symptom, and 1 with frequent urinary during observation period. Conclusion Lowdose
tolvaptan can promote Na level and urinary volume, improve heart function and stabilize BP and HR, has no
significant reverse reactions and has higher clinical efficacy and safety in super-elderly patients with CHF.

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