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目的观察托伐普坦联合呋塞米治疗I型心肾综合征超高龄患者的疗效及安全性。方法 6例超高龄I型心肾综合征患者,平均年龄(91.2±6.7)岁,在常规治疗基础上,予口服托伐普坦7.5~15 mg·d-1加呋塞米静脉滴注40~100 mg·d-1,疗程7 d。观察并记录患者每日血压、尿量、周围静脉压、心衰体征及不良事件。每3日检查肝、肾功能,N末端B型脑钠肽前体(N-pro-BNP),胱抑素C及电解质,进行疗效及安全性评估。结果与治疗前相比,所有患者在治疗第3日尿量显著增加[(2 158.3±366.6)m L vs.(753.3±110.1)m L(治疗前),P<0.01];周围静脉压显著下降[(11.5±0.8)cm H2O vs.(16.5±1.9)cm H2O,P<0.05];心衰体征缓解,血肌酐及胱抑素较治疗前下降,分别为[(108.6±50.6)μmol·L-1 vs.(153.6±77.5)μmol·L-1,P<0.05]和[(3.28±1.51)mg·L-1 vs.(4.60±2.54)mg·L-1,P<0.05],N-pro-BNP下降显著[(5 005.0±2 656.3)pg·m L-1 vs.(8 368.3±4 545.7)pg·m L-1,P<0.01]。患者均未发生高钠血症,未出现明显口渴及肝功能损害。结论托伐普坦联合呋塞米有效纠正I型心肾综合征超高龄患者的心衰症状,增加尿量,减轻肾损伤。
Objective To observe the efficacy and safety of tolvaptan combined with furosemide in the treatment of patients with super-advanced type I heart disease. Methods Six patients with super I-type heart-kidney syndrome (mean age 91.2 ± 6.7) were enrolled in this study. On the basis of conventional treatment, oral intravenous injections of tolvaptan 7.5 to 15 mg · d-1 plus furosemide 40 ~ 100 mg · d-1 for 7 days. Observe and record the daily blood pressure, urine output, peripheral venous pressure, heart failure signs and adverse events. The liver and renal function, N-pro-BNP, cystatin C and electrolytes were examined every 3 days for efficacy and safety evaluation. Results Compared with that before treatment, all the patients had a significant increase in urine output on the third day after treatment ([(2 158.3 ± 366.6) m L vs. (753.3 ± 110.1) m L before treatment, P 0.01] (11.5 ± 0.8) cm H 2 O vs. (16.5 ± 1.9) cm H 2 O, P <0.05]. The heart failure symptom relief, serum creatinine and cystatin decreased compared with those before treatment [(108.6 ± 50.6) μmol · L-1 vs. 153.6 ± 77.5 μmol·L-1, P <0.05 and [3.28 ± 1.51] mg · L-1 vs. (4.60 ± 2.54) mg · L-1, P <0.05] N-pro-BNP decreased significantly [(5 005.0 ± 2 656.3) pg · m L-1 vs. (8 368.3 ± 4 545.7) pg · m L-1, P <0.01]. Patients had no hypernatremia, no obvious thirst and liver damage. Conclusion The combination of tolvaptan and furosemide can effectively correct the symptoms of heart failure, increase urine output and reduce renal damage in patients with super-type I heart-heart syndrome.