中文摘要：

目的评价托伐普坦治疗老年慢性充血性心力衰竭（CHF）合并低钠血症及利尿剂抵抗患者的近期疗效及安全性。方法入选2015年3月~2016年5月于新乡市第二人民医院心内科的老年CHF合并低钠血症及利尿剂抵抗的患者100例，其中男性70例，女性30例。随机分成托伐普坦组（50例）和对照组（50例），在常规抗心力衰竭药物治疗的基础上，托伐普坦组给予托伐普坦；对照组给予3%~4%高渗盐水+大剂量呋塞米，两组均治疗7d。测定两组患者用药前后心率（HR）、平均动脉压（MAP）、体质量、血清钠、血清钾、左室射血分数（LVEF）、N末端脑钠肽前体（NT-proBNP）、抗利尿激素（ADH）、24h尿量、血尿素氮（BUN）、血清肌酐（Scr）、呋塞米日剂量、螺内酯日剂量及临床症状评分，记录药物的不良反应，统计出院后6个月内心血管病死率。结果治疗7d后，与治疗前相比，两组患者的血清钠、LVEF、24h尿量、NT-proBNP、ADH及临床症状评分均改善，差异具有统计学意义（P均＜0.01）。治疗7d后，托伐普坦组患者的血清钠、LVEF、24h尿量高于对照组，体质量、NTproBNP、ADH、呋塞米日剂量、螺内酯日剂量及临床症状评分低于对照组，差异具有统计学意义（P均＜0.05）。两组患者不良反应的发生率（12%vs.18%）比较，差异无统计学意义（P＞0.05）。两组患者6个月内的心血管病死率（4%vs.2%）比较，差异无统计学意义（P＞0.05）。结论老年CHF合并低钠血症及利尿剂抵抗的患者，应用托伐普坦在短期内可迅速改善心力衰竭的症状，升高血清钠浓度，减轻利尿剂抵抗，安全性好，但并不降低长期心血管病死率。

英文摘要：

Objective To review the curative effect and safety of tolvaptan in treatment of senile chroniccongestive heart failure(CHF)complicated by hyponatremia and diuretic resistance.Methods The patients(n=100,male70and female30)were chosen from the Department of Cardiovasology of the Second People’s Hospital ofXinxiang City from Mar.2015and May2016.All patients were randomly divided into tolvaptan group and controlgroup(each n=50),and on the base of routine anti-CHF therapy,the tolvaptan group was given tolvaptan andcontrol group was given3%-4%hypertonic saline and high-dose furosemide for7d.The heart rate(HR),meanarterial pressure(MAP),body mass,serum sodium,serum potassium,left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP),antidiuretic hormone(ADH),24-h urine volume,bloodurea nitrogen(BUN),serum creatinine(Scr),daily dose of furosemide,daily dose of spirolactone,clinical symptomscores and drug adverse reactions were detected,and fatality rate of cardiovascular diseases was recorded within6m after patients discharged from hospital in2groups.Results After treatment for7d,serum sodium,LVEF,24-hurine volume,NT-proBNP,ADH and clinical symptom scores were ameliorated in2groups(all P<0.01).Aftertreatment for7d,serum sodium,LVEF and24-h urine volume were higher,and body mass,NT-proBNP,ADH,daily dose of furosemide,daily dose of spirolactone and clinical symptom scores were lower in tolvaptan group thanthose in control group(all P<0.05).The difference in incidence of adverse reactions had no statistical significancebetween2groups(12%vs.18%,P>0.05).The difference in fatality rate of cardiovascular diseases had no statisticalsignificance between2groups(4%vs.2%,P>0.05)within6m after patients discharged from hospital.ConclusionTolvaptan can rapidly relieve CHF symptoms and diuretic resistance and promote serum sodium with higher safety,but cannot reduce long-term fatality rate of cardiovascular diseases.