摘要
目的观察托伐普坦在甲状腺功能亢进(甲亢)性心脏病合并心功能不全治疗中的效果和安全性。方法72例甲亢性心脏病合并心功能不全患者,随机分为托伐普坦组(34例)和呋塞米组(38例)。两组均采用螺内酯治疗,在此基础上,托伐普坦组采用托伐普坦治疗,呋塞米组采用呋塞米治疗。比较两组治疗前后心功能指标[左室射血分数(LVEF)、N末端B型利钠肽前体(NT-proBNP)、6 min步行试验距离]、24 h尿量、体重、电解质(血钠、血钾)、心律失常[心房颤动(房颤)、窦性心动过速(窦速)、心房扑动(房扑)、房性心动过速(房速)、房性早搏(房早)、室性早搏(室早)、室性心动过速(室速)、房室传导阻滞]发生情况,治疗1周后症状及体征(呼吸困难及下肢水肿)改善情况、肾功能指标[血肌酐、血尿素氮、估算肾小球滤过率(eGFR)],治疗期间不良反应发生情况。结果治疗1周后,两组患者NT-proBNP、6 min步行试验距离均较本组治疗前有明显改善,差异具有统计学意义(P<0.05);两组患者LVEF较本组治疗前无明显改善,差异无统计学意义(P>0.05)。治疗1周后,两组患者24 h尿量多于本组治疗前,体重低于本组治疗前,差异具有统计学意义(P<0.05)。治疗1周后,托伐普坦组血钾、血钠水平分别为(3.80±0.30)、(130.00±0.41)mmol/L,高于呋塞米组的(3.30±0.38)、(128.00±0.21)mmol/L,差异具有统计学意义(P<0.05)。治疗1周后,两组呼吸困难、下肢水肿改善率比较差异无统计学意义(P>0.05)。治疗1周后,两组血肌酐、血尿素氮、eGFR比较差异无统计学意义(P>0.05)。托伐普坦组治疗期间不良反应发生率5.9%(2/34)低于呋塞米组的21.1%(8/38),差异具有统计学意义(P<0.05)。治疗前及治疗1周后,两组房颤、窦速、房扑、房速、房早、室早、室速、房室传导阻滞发生率组间比较差异无统计学意义(P>0.05)。结论采用托伐普坦治疗甲亢性心脏病合并心功能不全效果肯定,和呋塞米相比效果无明显差别,但托伐普坦比呋塞米不良反应发生率低,对电解质的影响小,用药更安全。
Objective To observe the effect and safety of novel diuretic drug tolvaptan in patients with hyperthyroid heart disease complicated with cardiac insufficiency.Methods A total of 72 patients with hyperthyroid heart disease and cardiac insufficiency were randomly divided into tolvaptan group(34 cases)and furosemide group(38 cases).Both groups were treated with spironolactone,on this basis,the tolvaptan group was treated with tolvaptan,and the furosemide group was treated with furosemide.Both groups were compared in terms of cardiac function indexes[left ventricular ejection fraction(LVEF),N-terminal pro-B-type natriuretic peptide(NT-proBNP),6-min walking test distance],24-h urine output,body weight,electrolytes(serum sodium,serum potassium),occurrence of arrhythmias(atrial fibrillation,sinus tachycardia,atrial flutter,atrial tachycardia,premature atrial beats,premature ventricular beats,ventricular tachycardia,atrioventricular block),improvement of symptoms and signs(dyspnea and lower extremity edema)after 1 week of treatment,renal function indicators[serum creatinine,blood urea nitrogen,estimated glomerular filtration rate(eGFR)],occurrence of adverse reactions during treatment.Results After 1 week of treatment,the NT-proBNP and 6-min walking test distance in the two groups were significantly improved compared with those before treatment,and the difference was statistically significant(P<0.05).The LVEF of the two groups were not statistically significant compared with those before treatment(P>0.05).After 1 week of treatment,the 24-h urine output of the two groups was more than that of this group before treatment,and the body weight was lower than that of this group before treatment.All the differences were statistically significant(P<0.05).After 1 week of treatment,the serum potassium and serum sodium levels in tolvaptan group were(3.80±0.30)and(130.00±0.41)mmol/L,which were higher than(3.30±0.38)and(128.00±0.21)mmol/L in furosemide group,and the difference was statistically significant(P<0.05).After 1 week of treatment,there was no statistically significant difference in the improvement rates of dyspnea and lower extremity edema between the two groups(P>0.05).After 1 week of treatment,there was no statistically significant difference in serum creatinine,blood urea nitrogen and eGFR between the two groups(P>0.05).The incidence of adverse reactions in the tolvaptan group during treatment was 5.9%(2/34),which was lower than 21.1%(8/38)in the furosemide group,and the difference was statistically significant(P<0.05).Before treatment and after 1 week of treatment,there was no statistically significant difference in the incidence of atrial fibrillation,sinus tachycardia,atrial flutter,atrial tachycardia,premature atrial beats,premature ventricular beats,ventricular tachycardia,atrioventricular block between the two groups(P>0.05).Conclusion In the treatment of hyperthyroid heart disease with cardiac insufficiency,the effect of tolvaptan is positive,but not significantly different from that of furosemide.However,tolvaptan has a lower incidence of adverse reactions than furosemide,has less effect on electrolytes,and is safer to use.
作者
陈淑敏
侯贺功
李文晴
CHEN Shu-min;HOU He-gong;LI Wen-qing(Second Department of Cardiology,People's Hospital of Juye County,Heze 274900,China)
出处
《中国实用医药》
2022年第12期1-5,共5页
China Practical Medicine
