本文選題：托伐普坦　切入點(diǎn)：心力衰竭　出處：《中國(guó)藥房》2017年29期 　論文類型：期刊論文

【摘要】：目的:評(píng)估托伐普坦治療利尿劑抵抗心力衰竭患者的臨床效果及安全性。方法:回顧性分析2014年1月-2016年8月在重慶醫(yī)科大學(xué)附屬第一醫(yī)院心血管內(nèi)科病房住院的21例利尿劑抵抗心力衰竭患者的臨床資料。所有患者在接受大劑量袢利尿劑(呋塞米和/或托拉塞米)治療后,心力衰竭改善不明顯;后改為托伐普坦治療,其中19例患者口服托伐普坦片7.5 mg,qd,2例患者口服托伐普坦片15 mg,qd,均連續(xù)治療直至出院。比較21例患者治療前后的心功能、水腫程度、結(jié)局及體質(zhì)量、血壓、血鈉、血肌酐、血N末端B型利鈉肽原(NT-proBNP)水平和單位時(shí)間尿量的變化,并觀察不良反應(yīng)發(fā)生情況。結(jié)果:治療后,21例患者心功能明顯改善、水腫程度明顯減輕、收縮壓明顯降低、血鈉明顯升高、單位時(shí)間尿量明顯增多,與治療前比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);但治療前后體質(zhì)量、舒張壓、血肌酐和血NT-proBNP水平比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。21例患者中有1例出現(xiàn)口干,3例收縮壓較基礎(chǔ)值降低20 mm Hg及以上,4例舒張壓較基礎(chǔ)值降低10 mm Hg及以上。結(jié)論:對(duì)出現(xiàn)利尿劑抵抗的患者,托伐普坦能顯著增加其尿量、改善心功能、糾正低鈉血癥,且對(duì)收縮壓有降低作用。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of Tofaptan in the treatment of patients with diuretic resistance to heart failure. Methods: retrospective analysis was conducted from January 2014 to August 2016 in the Department of Cardiovascular Medicine, the first affiliated Hospital of Chongqing Medical University. All patients were treated with high-dose loop diuretics (furosemide and / or Tora Semide). The improvement of heart failure was not obvious, and was changed to torvalptan treatment. Among them, 19 patients were treated with oral Tofaptan tablet 7.5 mg / kg QD, and 2 patients were treated with Tofaptan tablet (15 mg / g QD) continuously until discharge. The cardiac function and edema of 21 patients were compared before and after treatment, and the degree of edema was compared before and after treatment. Outcome and body mass, blood pressure, blood sodium, serum creatinine, serum N-terminal B-type natriuretic peptide (NT-proBNPs) level and urine volume per unit time were observed and adverse reactions were observed. Results: the cardiac function of 21 patients was significantly improved after treatment. The degree of edema was obviously reduced, systolic blood pressure was decreased, blood sodium was obviously increased, urine volume per unit time was obviously increased, and there were significant differences between before and after treatment (P 0.05), but body mass, diastolic blood pressure, serum creatinine and NT-proBNP levels were compared before and after treatment. There was no significant difference in systolic blood pressure (SBP) between 1 case of 21 patients and 20 mm Hg of basal value and 4 cases of diastolic blood pressure decreased 10 mm Hg or more than the base value. Conclusion: to the patients with diuretic resistance, the systolic blood pressure of 3 cases is 20 mm Hg lower than the basic value and the diastolic blood pressure of 4 cases above the base value is lower than 10 mm Hg. Conclusion: there is no significant difference between the two groups. Tofaptan could significantly increase urine volume, improve cardiac function, correct hyponatremia, and decrease systolic blood pressure.
【作者單位】： 重慶醫(yī)科大學(xué)附屬第一醫(yī)院心血管內(nèi)科;重慶醫(yī)科大學(xué)公共衛(wèi)生與管理學(xué)院流行病學(xué)教研室;
【基金】：“十二五”國(guó)家科技支撐計(jì)劃項(xiàng)目(No.2011BAI11B01)
【分類號(hào)】：R541.6

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