摘要
目的探讨不同剂量托伐普坦治疗老年慢性心力衰竭(CHF)患者的临床效果。方法选取2020年1月至2023年1月于山东第一医科大学附属人民医院接受治疗的97例老年CHF患者作为研究对象,随机分为低剂量组(48例)和高剂量组(49例),其中低剂量组采用基础强心利尿+7.5 mg/d托伐普坦方案治疗,高剂量组采用基础强心利尿+15 mg/d托伐普坦方案治疗,对比两组患者治疗前后的心功能、每日尿量、6 min步行距离、血电解质变化,并对比两组患者的临床治疗效果及预后结局差异。结果治疗前后,两组患者的左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、左室射血分数(LVEF)、室间隔舒张末期厚度(IVST)、左心室后壁厚度(LPWT)、二尖瓣舒张早期和晚期血流速E峰/A峰(E/A)测定值进行比较,差异均无统计学意义(P>0.05);两组患者治疗后的LVDd、LVDs、IVST、LPWT测定值与本组治疗前比较均显著降低(P<0.05),LVEF、E/A测定值与本组治疗前比较均显著升高(P<0.05);治疗前,低剂量组和高剂量组患者尿量比较,差异无统计学意义(P>0.05);治疗后第3、5、7、14 d低剂量组患者的尿量显著低于高剂量组(P<0.05),两组的尿量与本组治疗前比较均升高(P<0.05);治疗前后,两组患者6 min步行距离、N末端脑钠肽前体(NT-proBNP)测定值组间比较,差异均无统计学意义(P>0.05);治疗后两组患者的6 min步行距离与治疗前比较均升高、NT-proBNP与治疗前比较均降低,差异均具有统计学意义(P<0.05);治疗前,两组患者的血钠、血钾、血氯组间比较,差异均无统计学意义(P>0.05);治疗后,两组患者的血钠、血钾较治疗前均升高(P<0.05);低剂量组血钠、血钾测定值低于高剂量组(P<0.05);治疗后,两组患者的临床疗效比较,无统计学差异(P>0.05);治疗后,低剂量组患者的不良反应发生率14.58%低于高剂量组患者的32.65%,差异具有统计学意义(P<0.05)。结论托伐普坦治疗老年CHF患者能取得较好的效果,15 mg/d与7.5 mg/d两种剂量比较,7.5 mg/d剂量在保证治疗效果的基础上,有助于减少不良反应的发生率。
Objective To investigate the clinical efficacy of different doses of tolvaptan in elderly patients with chronic heart failure(CHF).Methods Elderly CHF patients(n=97)were selected from People's Hospital Affi liated to Shandong First Medical University from Jan.2020 to Jan 2023,and randomly divided into low-dose group(n=48)and high-dose group(n=49).The low-dose group was given therapy of basic cardiotonic-diuretic and tolvaptan(7.5 mg/d),and high-dose group was given therapy of basic cardiotonic-diuretic and tolvaptan(15 mg/d).The changes of heart function,daily urine volume,6-minute walk distance(6MWD),and blood electrolytes were compared between 2 groups before and after treatment.The differences in clinical effi cacy and prognostic outcomes were compared between 2 groups.ResultsThe comparison had no statistical significance in left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),left ventricular ejection fraction(LVEF),interventricular septum thickness of end-diastole(IVSTd),left ventricular posterior wall thickness(LVPWT)and ratio of early diastolic mitral valve flow velocity to late diastolic mitral valve flow velocity(E/A)between 2 groups before and after treatment(P>0.05).The measured values of LVEDd,LVESd,IVSTd and LVPWT decreased signifi cantly(P<0.05),and LVEF and E/A increased significantly(P<0.05)in 2 groups after treatment.The comparison in urine volume had no statistical significance between 2 groups before treatment(P>0.05),and urine volume was signifi cantly lower in low-dose group than that in high-dose group on the 3rd,5th,7th and 14th d after treatment(P<0.05).The comparison in 6MWD and N-terminal probrain natriuretic peptide(NT-proBNP)had no statistical significance between 2 groups before treatment(P>0.05),and 6MWD increased and NT-proBNP decreased in 2 groups after treatment(P<0.05).The comparison in blood sodium,blood potassium and blood chlorine had statistical significance between 2 groups before treatment(P>0.05),and blood sodium and blood potassium increased in 2 groups after treatment(P<0.05).The measured values of blood sodium and blood potassium were lower in low-dose group than those in high-dose group(P<0.05).The comparison in clinical efficacy had no statistical significance between 2 groups after treatment(P>0.05).The incidence of adverse reactions was lower in low-dose group than that in highdose group(14.58%vs.32.65%,P<0.05).Conclusion Tolvaptan achieves good therapeutic effects in elderly CHF patients.When comparing 2 doses of 15 mg/day and 7.5 mg/day,the 7.5 mg/day dose helps reduce the incidence of adverse reactions while ensuring the therapeutic effect.
作者
李鸿渐
王思月
LI Hongjian;WANG Siyue(Department of Cardiology,People’s Hospital Affiliated to Shandong First Medical University,Jinan 271199,China)
出处
《中国循证心血管医学杂志》
2025年第11期1389-1393,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
托伐普坦
老年
慢性心力衰竭
心功能
tolvaptan
agedness
chronic heart failure
heart function
