托伐普坦联合托拉塞米治疗重症心力衰竭伴稀释性低钠血症的疗效及血液指标、心功能的影响观察

Efficacy of Tolvaptan Combined with Torasemide in Severe Heart Failure Complicated by Dilute Hyponatremia and the Effects on Blood Parameters and Cardiac Function

摘要: 目的：重症心力衰竭伴发稀释性低钠血症应用托伐普坦与托拉塞米联合治疗效果、心功能及血液指标分析。方法：选取2017年11月至2018年11月本院诊治120例重症心力衰竭伴发稀释性低钠血症患者，随机分两组，对照组予托拉塞米，研究组予托伐普坦与托拉塞米联合方案，分析两组患者临床疗效、心功能及血液指标情况。结果：(1) 对照组心力衰竭的治疗有效率是83.33%，较研究组的96.67%低，差异具统计学意义(P < 0.05)；对照组稀释性低钠血症的临床有效率为85.00%，较研究组的96.67%低，差异具统计学意义(P < 0.05)。(2) 治疗后，研究组LVESd (32.52 ± 3.49) mm、LVEDd (40.29 ± 4.31) mm比对照组低，LVEF (8.06 ± 6.52)%比对照组高(P < 0.05)；研究组血钠(143.06 ± 2.23) mmol/L、血浆渗透压比对照组高，BNP比对照组低(P < 0.05)。(3) 两组患者治疗前的生活质量评分对比，无统计学差异，P > 0.05；但是经过治疗后两组的生活质量平均均较治疗前有显著提升，但是研究组患者提升的幅度显著高于对照组，差异显著，有统计学意义(P < 0.05)。结论：重症心力衰竭伴发稀释性低钠血症应用托伐普坦与托拉塞米联合治疗，不仅能够改善患者的心功能指标水平和血液指标水平，而且还能大幅度提高患者的生活质量，进而获得满意的治疗效果，次疗法值得在临床中积极推广运用。

Abstract: Objective: To observe the efficacy of Tolvaptan combined with Torsemide in the treatment of pa-tients with severe heart failure complicated by dilute hyponatremia, and its effects on cardiac function and blood parameters. Methods: A total of 120 patients with severe heart failure compli-cated by dilute hyponatremia who had received treatment in the Hospital between November 2017 and November 2018 were enrolled. They were randomly divided into two groups, with the control group given Torasemide and the study group given Tolvaptan combined with Torasemide. The clinical efficacy, cardiac function and blood parameters in the two groups were analyzed. Results: (1) The effective rate of treatment of heart failure in control group was 83.33%, which was lower than that of study group (96.67%). The difference was statistically significant (P < 0.05). The clinical effective rate of dilute hyponatremia in the control group was 85.00%, which was lower than the study group’s 96.67%, and the difference was statistically significant (P < 0.05). (2) After treatment, LVESd (32.52 ± 3.49) mm and LVEDd (40.29 ± 4.31) mm of the study group were lower than the control group, LVEF (8.06 ± 6.52)% was higher than the control group (P < 0.05); the study group blood sodium (143.06 ± 2.23) mmol/L, plasma osmotic pressure was higher than that of the control group, and BNP was lower than the control group (P < 0.05). (3) There was no significant difference in the quality of life scores between the two groups before treatment, P > 0.05. However, the quality of life of the two groups was significantly higher than that before treatment, but the increase range of the patients in the study group was significantly higher than that of the control group. The difference was statistically significant (P < 0.05). Conclusion: The combination of tolvaptan and torsemide in the treatment of severe heart failure with dilute hyponatremia can not only improve the level of heart function and blood levels, but also greatly improve the quality of life of patients. To obtain satisfactory therapeutic effects, secondary therapy is worthy of active promotion in clinical practice.