Short-term Evaluation Of The Clinical Efficacy Of Combination Of Tolvaptan And Torasemide In Elder Heart Failure Patients

Objective:To observe the short-term efficacy and safety of tolvaptan combined with torasemide in treating with elder heart failure.Methods:1.90 aged patients with heart failure in the First Hospital of Shanxi Medical University in 2016 were retrospectively selected and divided into three groups:torasemide group,tolvaptan group and combination group,30 cases each.Each group was regularly treated with vasodilator,RAAS inhibitors,beta blockers and so on.Besides,torasemide group was given torasemide 40mg/d and tolvaptan group was treated with tolvaptan 15mg/d,while combination group was being treated with tolvaptan 15mg/d and torasemide 20mg/d,continuous treatment for 5 days.For the combination group,Wmedication time was tolvaptan 8 a.m.and torasemide 4 p.m.2.Collected 90 cases of elderly heart failure patients with general information,including age,gender,grade of heart function,heart failure disease,drug history,smoking history,diabetes history,blood biochemical indexes and family history of cardiovascular disease.Observation and recorded the amount of urine 24 h and evaluation of three groups of patients with dyspnea,pulmonary rales,edema and other symptoms of heart failure in patients before and after treatment.Daily check the patient’s cardiac function,electrolyte,renal function index,et al.In sixth days,serum sodium,serum potassium,NT-proBNP,Cys-C,eGFR,uric acid as observation indexes after treatment compared with the before.3.Using SPSS20.0 statistical software for statistical analysis.Mean±SD was used todescribe the quantitative data.Single factor analysis of variance was used to compare the three groups.When the test condition is not satisfied,the nonparametric test is used.The categorical data were expressed as percentage(%),using chi square test.H test for comparison of multi grade data.The difference was statistically significant with P<0.05.Results:1.Days of hospitalization in torasemide group was the longest,followed by the tolvaptan group combination group was the shortest(P<0.05).2.Compared three groups of patients with heart rate,the difference was not statistically significant(P>0.05);Tolvaptan group and combination group of systolic blood pressure,diastolic blood pressure,there was nostatistically significant difference(P>0.05);While the torasemide group of systolic blood pressure,diastolic blood pressure decreased significantly,the difference was statistically significant(P<0.05)3.After treatment,three groups of patients with heart failure symptoms were significantly improved.Compared with torasemide group,heart failure symptoms of patients in tolvaptan group and combination group had improved significantly and the difference was statistically significant(P<0.05).While there was no significant difference in tolvaptan group and combination group(P>0.05).4.Compared with torasemide group,24 h urine volume,serum sodium and eGFR level of patients in tolvaptan group and combination group had increased significantlyand the index of NT-proBNP,uric acid,serum cystatin had significantly decreased(P<0.05).5.Compared with tolvaptan group,24 h urine volume of patients in combination group increased significantly,and the level of NT-proBNP was significantly decreased(P<0.05),while there was no significant difference among serum sodium,serum potassium,uric acid,serum cystatin and eGFR(P>0.05)6.During the treatment,3 patients appeared dry mouth after drinking water.After the reduction of tolvaptan,it will significantly improved.Conclusion:Combination of tolvaptan and torasemide was effective for elder heart failure patients,which can increase serum sodium concentration and reduce the risk of kidney injury significantly.In addition the average hospitalization day had been shortened and the safety was good.