CAJ | 학술논문

目的：探讨托伐普坦对慢性重度心衰患者的治疗效果,并随访其半年内的死亡率。方法49例慢性重度心衰患者根据是否使用托伐普坦分为托伐普坦组(观察组,31例)与常规治疗组(对照组,18例)。记录两组患者的生命体征、电解质、每日清晨体重及液体出入量,观察心功能的改善情况。心脏彩色多普勒测定左室舒张末期内径( LVEDD)及左室射血分数( LVEF)。测定血清肾素( PRA)、血管紧张素Ⅱ( PRA)、醛固酮( ALD)、去甲肾上腺素( NE)、血清氮末端脑钠素原( NT-proBNP)水平及抗利尿激素( ADH)水平。随访患者半年内的死亡相关终点事件。结果治疗后,托伐普坦组患者心功能明显改善(P<0．05)。用药24 h内,托伐普坦组患者尿量明显增加,体重迅速降低(P<0．01),血清钠、氯浓度提高(P<0．05)。治疗后,两组LVEDD比较差异无统计学意义(P>0．05),但托伐普坦组的LVEF值高于常规治疗组,差异有统计学意义(P<0．01)。托伐普坦组血清神经内分泌因子水平降低(P<0．05)。随访6个月,两组死亡率比较差异无统计学意义(P>0．05)。结论托伐普坦可迅速改善心功能,纠正低钠低氯血症,抑制神经内分泌因子,且不增加死亡风险。
목적：탐토탁벌보탄대만성중도심쇠환자적치료효과,병수방기반년내적사망솔。방법49례만성중도심쇠환자근거시부사용탁벌보탄분위탁벌보탄조(관찰조,31례)여상규치료조(대조조,18례)。기록량조환자적생명체정、전해질、매일청신체중급액체출입량,관찰심공능적개선정황。심장채색다보륵측정좌실서장말기내경( LVEDD)급좌실사혈분수( LVEF)。측정혈청신소( PRA)、혈관긴장소Ⅱ( PRA)、철고동( ALD)、거갑신상선소( NE)、혈청담말단뇌납소원( NT-proBNP)수평급항이뇨격소( ADH)수평。수방환자반년내적사망상관종점사건。결과치료후,탁벌보탄조환자심공능명현개선(P<0．05)。용약24 h내,탁벌보탄조환자뇨량명현증가,체중신속강저(P<0．01),혈청납、록농도제고(P<0．05)。치료후,량조LVEDD비교차이무통계학의의(P>0．05),단탁벌보탄조적LVEF치고우상규치료조,차이유통계학의의(P<0．01)。탁벌보탄조혈청신경내분비인자수평강저(P<0．05)。수방6개월,량조사망솔비교차이무통계학의의(P>0．05)。결론탁벌보탄가신속개선심공능,규정저납저록혈증,억제신경내분비인자,차불증가사망풍험。
Objective To explore the effect of tolvaptan on severe chronic heart failure(SCHF),and follow up the mortality during six months. Methods Forty-nine SCHF patients were divided into 2 groups: tolvaptan group (n=31) and conventional treatment group (n=18). The vital signs,serum electrolyte,daily weight,liquid intake and output were recorded. Left ventricular end diastolic diameter ( LVEDD) and left ventricular ejection fraction ( LVEF) were measured by color doppler echocardiography. The levels of serum Renin ( PRA) ,angiotensinⅡ( AngⅡ) ,aldoste-rone (ALD),antidiuretic hormone (ADH),norepinephrine (NE) and N-terminal pro brain natriuretic peptide (NT-proBNP) were measured. The death related events were followed up for six months. Results After treatment,the heart function in patients of tolvaptan group was improved (P<0. 05). At 24 h after medication,the urine volume of tolvap-tan group increased significantly,the weight reduced (P<0. 01),and the serum sodium and chloride concentration in-creased ( P<0. 05 ) . After treatment, there was no significant difference in LVEDD between the two groups ( P >0. 05),but the level of LVEF in tolvaptan group was higher than that of conventional treatment group (P<0. 01). The levels of serum neuroendocrine factors in tolvaptan group decreased (P<0. 05). There was no significant difference in death related events between the two groups during the six months of follow up ( P>0. 05 ) . Conclusion Tolvaptan could quickly improve the heart function,attenuate the hyponatremia and hypochloremia,inhibit neuroendocrine factors and do not increase the risk of death.