托伐普坦与托拉塞米在慢性心力衰竭急性发作患者中的疗效对比

摘要

Objective To compare the clinical efficacy between tolvaptan and torasemide in treatment of acute attack of chronic heart failure (CHF).Methods CHF patients (n=124, male 69 and female 55) were chosen from the Taihe Hospital of Hubei University of Medicine from Jan. 2014 to Mar. 2015. All patients were divided, according to random digital table, into tolvaptan group and torasemide group (eachn=62). The patients in 2 groups were given routine anti-CHF therapy, and tolvaptan group was orally given tolvaptan additionally and torasemide group, torasemide additionally. The levels of serum potassium, serum sodium and serum creatinine (SCr) were detected, left ventricular ejection fraction (LVEF) was measured with ultrasound examination, and 24-h urine volume was recorded every day in 2 groups at the time of hospitalization and after treatment for 7 d. The symptoms and signs (lung rale, edema of lower extremity and dyspnea) were reviewed.Results The symptoms of lung rale, edema of lower extremity and dyspnea were significantly relieved in 2 groups after treatment for 7 d, which was more significant in tolvaptan group (allP<0.05). The difference in levels of SCr, serum potassium and serum sodium had no statistical significance in 2 groups before and after treatment (allP>0.05). The level of LVEF increased in 2 groups after treatment, which was more significant in tolvaptan group (allP<0.05). The urine volume increased significantly in tolvaptan group compared with torasemide group after treatment for 4 d (allP<0.05).Conclusion Compared with torasemide, tolvaptan has more significant effects of relieving symptoms and signs and improving heart function, and has no influence on kidney function in patients with acute attack of CHF.%目的 对比托伐普坦与托拉塞米在慢性心力衰竭急性发作患者中的临床疗效.方法 选择2014年1月~2015年3月于湖北医药学院附属太和医院收入治疗的慢性心力衰竭急性发作患者124例,其中男性69例,女性55例.利用随机数字法分为托伐普坦组(62例)和托拉塞米组(62例).两组患者均采用常规抗心力衰竭治疗,托伐普坦组在此基础上口服托伐普坦,托拉塞米组口服托拉塞米.检测两组入院时及治疗7 d后的血钾、血钠和肌酐,超声测定左室射血分数(LVEF),记录24 h尿量.评估心力衰竭症状和体征(肺部啰音、下肢水肿、呼吸困难).结果 与治疗前比较,治疗7 d后两组肺部啰音、下肢水肿、呼吸困难明显改善,托伐普坦组改善更明显,差异有统计学意义(P均<0.05).两组治疗前后肌酐、血钾和血钠比较,差异无统计学意义(P均>0.05).两组治疗后较治疗前LVEF均升高,托拉普坦组升高更明显,差异有统计学意义(P均<0.05).与托拉塞米组比较,托伐普坦组治疗4 d后的尿量明显增多,差异有统计学意义(P均<0.05).结论 与托拉塞米比较,托伐普坦治疗慢性心力衰竭急性发作患者心力衰竭症状、体征和心功能改善更明显,且不影响肾功能.