【摘要】 目的观察不同剂量托伐普坦治疗老年慢性心力衰竭（CHF）伴利尿剂抵抗患者的疗效与安全性。方法选择老年CHF伴利尿剂抵抗患者60例,随机分为观察组（托伐普坦15mg/d口服联合呋塞米100mg/d持续静脉注射）和对照组（托伐普坦30～60mg/d口服）,每组30例。监测比较2组治疗前与治疗5d的尿量变化及临床疗效;记录比较2组高钠血症等不良反应发生率。结果治疗后2组尿量均显著增多,持续增加至3d时达高峰,此后维持相近水平至观察期结束(F_{主体内效应}=299.784,P<0.01);2组间尿量比较差异无统计学意义(F_{主体间效应}=1.119,P=0.294)。观察组平均托伐普坦用量明显低于对照组,差异有统计学意义[（11.75±3.78）mg/d vs （41.50±12.88）mg/d,P<0.01]。观察组与对照组的总有效率、总不良反应发生率比较无统计学差异（93.33%vs 90.00%,P=1.000;53.33%vs 63.33%,P=1.000）;观察组高钠血症发生率显著低于对照组（6.67%vs 33.33%,P=0.021）。结论托伐普坦能有效改善老年CHF患者的利尿剂抵抗,提高临床疗效;中大剂量托伐普坦显著增加高钠血症发生;联合应用低剂量托伐普坦与排钠利尿剂在降低高钠血症的同时未降低临床疗效。更多还原

【Abstract】 Objective To study the efficiency and safety of tolvaptan in elderly CHF patients with DR.Methods Sixty elderly CHF patients with DR were randomly divided into observation group(n=30)and control group(n=30).The patients in observation group were treated with tolvaptan(15 mg/d)combined with furosemide(100 mg/d)and those in control group were treated with tolvaptan(30-60 mg/d).Their daily urinary volume and therapeutic effect were compared before treatment and on day 5 after treatment.The incidence of adverse reactions such as hypernatremia was recorded.Results The urinary volume was significantly greater in two groups and reached its peak on day 3 after treatment and maintained at its peak by the end of observation period(F=299.784,P<0.001).No significant difference was detected in urinary volume between the two groups(F=1.119,P=0.294).The average dose of tolvaptan was significantly lower in observation group than in control group(P<0.01).No significant difference was detected in total effective rate and total incidence of adverse reactions between the two groups(P=1.000).The incidence of hypernatremia was significantly lower in observation group than in control group(6.67%vs 33.33%,P=0.021).Conclusion Tolvaptan can effectively improve the DR and therapeutic effect in elderly CHF patients.Moderate-large tolvaptan dose can significantly increase the incidence of hypernatremia.Tolvaptan combined with furosemide can reduce the incidence of hypernatremia but not its therapeutic effect.更多还原