标题：托伐普坦联合重组人脑利钠肽治疗老年慢性心力衰竭合并利尿剂抵抗患者的效果及对心功能的影响

      作者：范顺娟 1，罗先虎 2，毛小运 1    重庆三峡医药高等专科学校附属人民医院康复医学科 1、心血管内科 2，重庆 404100

      卷次： 2021年32卷20期

      【摘要】 目的 探讨托伐普坦联合重组人脑利钠肽治疗老年慢性心力衰竭合并利尿剂抵抗患者的效果及对心功能的影响。方法 回顾性分析2018年11月至2019年11月重庆三峡医药高等专科学校附属人民医院接诊的80例老年慢性心力衰竭合并利尿剂抵抗患者的临床资料，按治疗方式分为观察组和对照组，每组40例。对照组患者在常规治疗的基础上给予托伐普坦治疗，观察组患者在对照组治疗的基础上联合重组人脑利钠肽静脉冲击治疗，两组均连续治疗两周。治疗两周后，比较两组患者的临床疗效、治疗后一般情况、治疗前后左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、每搏输出量(SV)、心脏指数(CI)、血清N端B型钠尿肽原(NT-proBNP)水平及不良反应发生情况。结果 观察组患者的临床治疗总有效率为95.0%，明显高于对照组的80.0%，差异具有统计学意义(P<0.05)；治疗后，观察组患者的输液量、尿液量明显多于对照组，住院时间明显短于对照组，差异均具有统计学意义(P<0.05)；治疗后，观察组患者的LVEDD、LVESD水平明显低于对照组，LVEF、SV、CI水平明显高于对照组，差异均具有统计学意义(P<0.05)；治疗后，观察组患者的血清NT-proBNP明显低于对照组，差异具有统计学意义(P<0.05)；观察组和对照组患者的不良反应总发生率分别为 7.50%、22.5%，差异无统计学意义(P>0.05)。结论 托伐普坦联合重组人脑利钠肽治疗老年慢性心力衰竭合并利尿剂抵抗可有效缩短患者住院时间，改善心功能和血清NT-proBNP水平，降低低血压发生率，临床治疗效果显著。
      【关键词】 慢性心力衰竭；利尿剂抵抗；托伐普坦；重组人脑利钠肽；心功能；N端B型钠尿肽原
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2021）20—2611—04

Effect of torvaptan combined with recombinant human brain natriuretic peptide in the treatment of elderlypatients with chronic heart failure complicated with diuretic resistance and its effect on cardiac function.
FANShun-juan 1, LUO Xian-hu 2, MAO Xiao-yun 1. Department of Rehabilitation Medicine 1, Internal Medicine-CardiovascularDepartment 2, the Affiliated People's Hospital of Chongqing Three Gorges Medical College, Chongqing 404100, Sichuan,CHINA
【Abstract】 Objective To study effect of torvaptan combined with recombinant human brain natriuretic peptidein the treatment of elderly patients with chronic heart failure complicated with diuretic resistance and its effect on cardi-ac function. Methods The clinical data of 80 elderly patients with chronic heart failure complicated with diuretic resis-tance admitted to the Affiliated People's Hospital of Chongqing Three Gorges Medical College from November 2018 toNovember 2019 were retrospectively analyzed. The patients were divided into an observation group and a control groupaccording to the different treatment methods, with 40 patients in each group. The patients in the control group were giv-en torvaptan in addition to conventional treatment, and the patients in the observation group were treated with intrave-nous pulse therapy of recombinant human brain natriuretic peptide on the basis of the treatment in the control group,both for 2 consecutive weeks. After 2 weeks of treatment, the clinical efficacy, general condition after treatment, left ven-tricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection frac-tion (LVEF), stroke volume (SV), cardiac index (CI), serum N-terminal pro-B natriuretic peptide (NT-proBNP), and ad-verse reactions were compared between the two groups. Results After treatment, the total effective rate of the observa-tion group was 95.0%, which was significantly higher than 80.0% of the control group (P<0.05). After treatment, the pa-tients in the observation group had more fluids and urine than the control group, and the length of hospital stay was short-er than that of the control group (P<0.05). After treatment, the LVEDD and LVESD levels of the observation group werelower than those of the control group, and the LVEF, SV, and CI levels were higher than those of the control group, allwith statistically significant difference (P<0.05). After treatment, the serum NT-proBNP of the observation group waslower than that of the control group (P<0.05). The total incidence of adverse reactions in observation group and controlgroup was 7.50% and 22.5%, and the difference was not statistically significant (P>0.05). Conclusion The clinical ef-fect of tolvaptan combined with recombinant human brain natriuretic peptide in the treatment of elderly patients with