托拉塞米片治疗充血性心力衰竭并发低钠血症的临床疗效观察

71临床研究2020年11月第28卷第11期作者简介：李海英（1977—），女，汉族，河南延津人，副主任医师，本科。

研究方向：心力衰竭防治方面。

·临床治疗·托伐普坦联合托拉塞米治疗重症心力衰竭伴稀释性低钠血症的疗效及安全性观察李海英(河南省郑州市金水区总医院 内一科，河南 郑州 450000)摘要：目的 分析托伐普坦联合托拉塞米对重症心力衰竭伴稀释性低钠血症的疗效和安全性。

方法 将2016年1月—2019年12月本院收治的82例重症心力衰竭伴稀释性低钠血症患者作为研究对象，依据随机数表法分成对照组(予以托拉塞米)和观察组(于对照组基础上加用托伐普坦)，各41例，比较两组总有效率、治疗前后左室收缩末期内径(LVESd)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、血钠、血浆渗透压以及脑钠肽(BNP)水平和不良反应情况。

结果 观察组心力衰竭、稀释性低钠血症总有效率显著高于对照组，差异有统计学意义(P＜0.05)。

治疗后，观察组LVEF、血钠及血浆渗透压显著高于对照组，LVFSD及LVEDD显著低于对照组，差异有统计学意义(P＜0.05)。

两组不良反应对比差异无统计学意义(P＞0.05)。

结论 托伐普坦联合托拉塞米对重症心力衰竭伴稀释性低钠血症疗效确切，且安全性较高，值得采用。

关键词：稀释性低钠血症；重症心力衰竭；托拉塞米；托伐普坦；疗效；安全性中图分类号：R541.6文献标志码：A 文章编号：2096―1278(2020)11―0071―03心力衰竭是各类心血管疾病发展至终末阶段的结果，属于心内科一类严重病症，临床症状有运动耐力下降、呼吸乏力及水肿等。

当患者于静息状态下产生呼吸困难即为重症心力衰竭，而稀释性低钠血症属于重症心力衰竭患者常见并发症之一，也是心力衰竭患者死亡的一个主要原因[1-2]。

以往临床治疗多选择利尿剂方案，但治疗期间易出现稀释性低钠血症，患者的病死率较高[3-4]。

Asian Case Reports in Emergency Medicine 亚洲急诊医学病例研究, 2019, 7(3), 13-19Published Online August 2019 in Hans. /journal/acremhttps:///10.12677/acrem.2019.73003Efficacy of Tolvaptan Combined withTorasemide in Severe Heart FailureComplicated by Dilute Hyponatremiaand the Effects on Blood Parametersand Cardiac FunctionNing Wang1, Zhili Zhou1, Rongjia Yang2*1Emergency Department, Qingyang People's Hospital of Gansu Province, Qingyang Gansu2Emergency Department, Gansu Provincial Hospital, Lanzhou GansuReceived: Aug. 9th, 2019; accepted: Aug. 23rd, 2019; published: Aug. 30th, 2019AbstractObjective: To observe the efficacy of Tolvaptan combined with Torsemide in the treatment of pa-tients with severe heart failure complicated by dilute hyponatremia, and its effects on cardiac function and blood parameters. Methods: A total of 120 patients with severe heart failure compli-cated by dilute hyponatremia who had received treatment in the Hospital between November 2017 and November 2018 were enrolled. They were randomly divided into two groups, with the control group given Torasemide and the study group given Tolvaptan combined with Torasemide.The clinical efficacy, cardiac function and blood parameters in the two groups were analyzed. Re-sults: (1) The effective rate of treatment of heart failure in control group was 83.33%, which was lower than that of study group (96.67%). The difference was statistically significant (P < 0.05). The clinical effective rate of dilute hyponatremia in the control group was 85.00%, which was lower than the study group’s 96.67%, and the difference was statistically significant (P < 0.05). (2) After treatment, LVESd (32.52 ± 3.49) mm and LVEDd (40.29 ± 4.31) mm of the study group were lower than the control group, LVEF (8.06 ± 6.52)% was higher than the control group (P < 0.05); the study group blood sodium (143.06 ± 2.23) mmol/L, plasma osmotic pressure was higher than that of the control group, and BNP was lower than the control group (P < 0.05). (3) There was no sig-nificant difference in the quality of life scores between the two groups before treatment, P > 0.05.However, the quality of life of the two groups was significantly higher than that before treatment, but the increase range of the patients in the study group was significantly higher than that of the control group. The difference was statistically significant (P < 0.05). Conclusion: The combination of tolvaptan and torsemide in the treatment of severe heart failure with dilute hyponatremia can not only improve the level of heart function and blood levels, but also greatly improve the quality of life of patients. To obtain satisfactory therapeutic effects, secondary therapy is worthy of active promotion in clinical practice.*通讯作者。

托拉塞米治疗慢性充血性心力衰竭的疗效及安全性分析赵振梅，阎巍，吴岩松，营口市中心医院心内科，辽宁营口115000【摘要】目的：观察托拉塞米治疗慢性充血性心力衰竭患者的临床疗效及安全性。

方法：选取98例慢性充血性心力衰竭患者，将其随机分为托拉塞米组与呋塞米组，在心力衰竭常规治疗方法一致的情况下，分别予托拉塞米与呋塞米20mg静推。

治疗10d后，记录两组患者治疗前后血压、血钾浓度、BNP值及EF值。

结果：两组患者血压均有下降．但组间差异无统计学意义；托拉塞米组低血钾发生率更低，BNP下降且心功能改善更明显。

结论：托拉塞米可显著改善慢性充血性心力衰竭患者的心功能，降低血浆BNP水平，低血钾及血压变化等不良反应较轻。

【关键词】托拉塞米；充血性心力衰竭；疗效及安全性【中图分类号】R541．6 【文献标识码】BCurative effect and safety analysis of torasemide used to chronic congestive heartfailureZHAO zhenmei,YAN wei,WU yansong,Department of Cardiology,Central Hospital of Yingkou, Yingkou 115000, China 【Abstract】Objective：To observe the curative effect and safety of torasemide used to cure chronic congestive heart failur．Methods：98 patients with chronic CHF were randomly divided in two groups，the torasemide group and the furosemide group．In the case of The same conventional treatment of CHF。

托拉塞米和呋塞米治疗慢性心力衰竭的临床疗效观察目的：探究托拉塞米和呋塞米治疗慢性心力衰竭的临床疗效。

方法：选择笔者所在医院自2012年1月-2014年12月收治的诊断为慢性心力衰竭的90例患者，将其按照随机数字表法分为对照组和观察组两组，每组各45例，对照组给予呋塞米注射液治疗，观察组给予托拉塞米注射液治疗，观察两组患者的心功能，水肿改善情况，治疗前后尿钾、尿钠、尿氯含量及不良反应发生情况并进行对比。

结果：观察组总有效率为93.33%；对照组总有效率为75.56%，两组比较，差异有统计学意（P＜0.05）；观察组水肿消失率为73.33%；对照组71.11%，差异无统计学意（P>0.05）；治疗后，观察组患者的尿纳和尿钾水平较治疗前显著降低，差异有统计学意义（P＜0.05）；对照组尿钾降低水平更加显著，差异有统计学意义（P＜0.05）；两组间尿纳变化情况比较差异无统计学意义（P>0.05）；两组治疗后尿量较治疗前显著增加，且观察组明显高于对照组，差异有统计学意义（P ＜0.05）；对照组发生不良反应的例数为14例（31.11%）明显高于观察组的8例（17.78%），差异有统计学意义（P＜0.05）。

结论：应用托拉塞米注射液治疗慢性心力衰竭疗效显著，具有见效快、不良反应发生率低的特点，且安全性高，值得在临床上借鉴和使用。

标签：托拉塞米；呋塞米；慢性心力衰竭；临床疗效慢性心力衰竭是临床上的常见疾病之一，分为左心力衰竭、右心力衰竭及全心力衰竭，左心力衰竭的临床症状是左心室代偿功能不全引起肺淤血、肺水肿，有呼吸困难（包括劳力性呼吸困难、端坐呼吸、夜间阵发性呼吸困难）、咳嗽、咳痰，甚至咯血等；而右心力衰竭的特点是由于右心力衰竭引起的体循环静脉淤血和水钠潴留，表现为上腹部胀满、颈静脉怒张、水肿、紫绀、神经系统症状（可有神经过敏、失眠、嗜睡等）、心脏体征[1]。

对于其治疗主要是减轻心脏前后负荷，利尿剂的使用不容小视，临床上传统的利尿剂药物是呋塞米，但由于部分患者使用该药物会产生电解质紊乱、低尿钾等不良反应，而托拉塞米是利尿剂的新型药物，具有的特点是见效快、药效持久、给药剂量轻、副作用少等[2]。

托拉塞米治疗慢性心力衰竭的临床观察刘辉;王学惠;张永春;陈志刚【期刊名称】《中国药房》【年(卷),期】2016(27)29【摘要】OBJECTIVE:To observe clinical efficacy and safety of torasemide in the treatment of chronic heart failure(CHF). METHODS:94 patients with CHF were selected and randomly divided into control group and observation group,with 47 cases in each group. Control group were treated with routine treatment,such as bed rest,oxygen inhalation,control of total body fluid in-take,routine anti-heart failure therapy and use of diuretic in 24 h. Based on the above treatment,observation group were treated with Torasemide injection with initial dose of 5-10 mg,qd,gradually increasing to 20 mg/d,maximal does of 40 mg/d. Both group re-ceived 7 days of continuous treatment. Clinical efficacies were observed in 2 groups as well as serum potassium and sodium,Scr,24 h urine volume and the rate ofⅠ-Ⅱgrade cardiac function before and after treatment. The occurrence of ADR was compared between 2 groups. RESULTS:The total effective rate of observation group was 61.70%,which was significantly higher than that of control group (46.81%),with statistical significance (P<0.05). There was no statistical significance in serum potassium and sodium and Scr between 2 groups before and after treatment(P>0.05). There was no statistical significance in 24 h urine volume and the rate ofⅠ-Ⅱgrade cardiacfunction between 2 groups before and after treatment(P>0.05);after treatment,24 h urine volume and the rate ofⅠ-Ⅱgrade cardiac function of 2 groups were increased significantly,the observation group was higher than the control group, with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Torasemide is effective for CHF,and can promote diuresis and the recovery of cardiac function with good safety.%目的：观察托拉塞米治疗慢性心力衰竭（CHF）患者的临床疗效及安全性。

托拉塞米治疗心力衰竭疗效观察目的：观察对比托拉塞米与呋塞米分别短期应用治疗心力衰竭的疗效及安全性。

方法：随机将心力衰竭患者分为托拉塞米组（48例）和呋塞米组（46例），治疗3天，比较两组有效性，治疗中24小时出入量及差值，治疗前后血钾、血钠水平。

结果：托拉塞米组总有效率高于呋塞米组（P＜O.05），托拉塞米组较呋塞米组利尿作用更强（P＜O.05），两组治疗前后，血钾、血钠均下降，托拉塞米组患者血钾下降水平低于呋塞米组（P＜O.05），血钠水平变化两组无统计学差异（P>0.05）。

结论：短期应用托拉塞米治疗心力衰竭相对于呋塞米疗效好，安全性高。

标签：心力衰竭；托拉塞米；呋塞米；疗效；安全性心力衰竭是由于心脏的收缩功能和或舒张功能发生障碍，不能将静脉回心血量充分排出心脏，导致静脉系统血液淤积，动脉系统血液灌注不足，从而引起心脏循环障碍症候群，根据发病的缓急分为慢性心力衰竭与急性心力衰竭，托拉塞米是作用于肾小管髓袢的高效利尿药，被广泛用于治疗急、慢性心力衰竭，本文通过观察托拉塞米注射液对心力衰竭患者的临床作用，分析其疗效及安全性。

1 资料与方法1.1 病例选择2011年11～2014年3月收住入院的急性心力衰竭患者94例，所有患者均排除急性心肌梗死、肾功能衰竭无尿、严重低血压及低钠低钾。

男44例，女50例，年龄45～86岁，平均（69.1±l1.4）岁，心功能分级为Ⅲ～Ⅳ级（NYHA）。

将患者随机分为2组。

①托拉塞米组48例，男22例，女26例，年龄45～82岁，平均（67.4±10.9）岁；②呋塞米组46例，男22例，女24例，年龄48～86岁，平均（70.9+-11.6）岁。

各组患者性别及年龄差异无统计学意义，具有可比性。

1.2 方法所有患者于入院前72小时内均未使用利尿剂，入院后均使用利尿剂，包括静脉注射托拉塞米40 mg/d或呋塞米40mg/d。

具体方法：托拉塞米组，静脉注射托拉塞米40 mg/d；呋塞米组：使用静脉呋塞米40 mg/d；疗程3天。