CAJ | 학술논문

目的：观察托伐普坦治疗顽固性心力衰竭中严重利尿剂抵抗的疗效。方法对经大剂量利尿剂（速尿大于200mg/d）治疗效果不佳，且不伴有严重低钠血症的顽固性心力衰竭患者3例给予托伐普坦15mg/d治疗，观察治疗后体重、尿量、血肌酐、肝功能、电解质的变化。结果治疗1d后体重平均减轻3.16kg；尿量平均增加5540ml；治疗3~5d后血肌酐指标2例降至正常，另外1例较前有轻度改善；肝功能、电解质无明显变化。结论托伐普坦能有效治疗严重利尿剂抵抗，有助于心肾功能改善，疗效较好，无明显不良反应发生。
목적：관찰탁벌보탄치료완고성심력쇠갈중엄중이뇨제저항적료효。방법대경대제량이뇨제（속뇨대우200mg/d）치료효과불가，차불반유엄중저납혈증적완고성심력쇠갈환자3례급여탁벌보탄15mg/d치료，관찰치료후체중、뇨량、혈기항、간공능、전해질적변화。결과치료1d후체중평균감경3.16kg；뇨량평균증가5540ml；치료3~5d후혈기항지표2례강지정상，령외1례교전유경도개선；간공능、전해질무명현변화。결론탁벌보탄능유효치료엄중이뇨제저항，유조우심신공능개선，료효교호，무명현불량반응발생。
Objective To observe the clinical effect of Tolvaptan on severe diuretic resistance in refractory heart failure. Methods 3 cases of patient with refractory heart failure and without severe hyponatremia had no good curative effect after large dose of diuretics (the dose of furosemide was more than 200mg/d) therapy, were treated with Tolvaptan (15mg/d). The changes of body weight, urine volume, serum creatinine, liver function, electrolytes were observed after treatment. Results One day after treatment,body weight reduced 3.16kg on average, urine output reached 5 540ml on average. In the 3~5 days after treatment, creatine level dropped to normal in 2 cases, another case showed a slight decreasing tendency. Hepatic function and electrolyte had no obvious change. Conclusion Tolvaptan is effective in treating severe diuretic resistance,and helpful to improve car-diac and renal function,the curative effect is good,and has no significant adverse events.