摘要
目的观察托伐普坦联合呋塞米治疗急性心力衰竭超高龄老年患者的近期疗效及安全性。方法2013年1月至2014年12月在本院干诊科住院的9例超高龄急性心力衰竭老年患者．平均年龄（95．2±7．5）岁。在维持长期治疗方案基础上，予呋塞米40mg·d^-1静脉推注及奈西立肽（0．0075～0．01μg·kg^-1·min^-1）持续泵注治疗3d后，心力衰竭症状控制不满意者在此治疗基础上加用托伐普坦7．5mg·d^-1口服3d后，停静脉注射呋塞米及奈西利肽，将托伐普坦改为7．5mg，qod，联合口服呋塞米40-60mg·d^-1治疗7d后停用托伐普坦。观察记录患者每日的血压、心率、尿量、心衰体征及不良事件。定期检查肝、肾功能，N末端B型脑钠肽前体（N-pro-BNP）及电解质，进行疗效及安全性评估。结果在原治疗基础上，相比单用呋塞米治疗，联合托伐普坦治疗后所有患者尿量显著增加，联合治疗第3日尿量增加最为明显[（2504．6±388．7）vs．（1030．8±110．7）mL，P〈0．01]；联合治疗第3日心力衰竭体征缓解明显，第7日N-pro-BNP下降基线水平50％以上（P〈0．01）。未出现高钠血症及低血压状态。无明显口渴及肝功损害。结论托伐普坦联合呋塞米有效增加尿量，纠正急性心力衰竭超高龄患者的心力衰竭症状，改善其近期预后。无严重不良事件发生。
AIM To evaluate the efficacy of patients with acute heart failure. METHODS A total 7.5 years） admitted in our department from January tolvaptan in combination with furosemide in very elderly of 9 patients with acute heart failure （average age 95.2 ± 2013 to December 2014 were enrolled in this study. At first, all patients were given routine treatment, intravenous furosemide 40 mg, qd and nesiritide （0.007 5 - 0.01 μg.kg^-1min^-1） continuous intravenous for 3 days, followed by a 3-day treatment period with tolvaptan （7.5 mg.d^-1 oral） in addition. When intravenous furosemide was changed to oral use and nesiritide was also stopped, the administration of tolvaptan was changed to intermittent oral for 7 days and then stopped. The primary end points were blood pressure, heart rate, urine volume, sign of heart failure, the function of liver and kidney, serum levels of N-Pro-BNP, the serum sodium concentration and all adverse events were observed. RESULTS Urine volume of all patients increased significantly after combined with tolvaptan compared to treatment with furosemide. On the third day of combinative treatment, the total urine volume was increased up to the highest （2 504.6 ± 388.7 vs. 1 030.8 ± 110.7） mL, P 〈 0.01）. The changes of sign of heart failure were released significantly, blood levels of N-pro-BNP were reduced significantly by 50% of baseline level （P 〈 0.01）. Hypernatremia and hypotension were not happened. There were no drug related adverse events of thirst and liver dysfunction. CONCLUSION Tolvaptan with furosemide could effectively increase urine volume, released the signs of heart failure and improve the short-term prognosis of very elderly patients with acute heart failure, without serious adverse events.
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2015年第9期683-687,共5页
Chinese Journal of New Drugs and Clinical Remedies
