| Backround: With the acceleration of population aging process and the development of the world's health level,Patients hospitalized for heart failure and increased year by year,And refractory heart failure is a stage of various kinds of development to end-stage heart disease,Hyponatremia and diuretic resistance is also more common,Which bring up difficulty in heart failure treatment,Tolvaptan,as an arginine vasopressin V2 receptor antagonist,on renal distal convoluted tubules diuretic effect,become a new type of diuretic in refractory heart failure treatment.Object:This study by observing the application tolvaptan after treatment in patients with heart failure symptoms,signs of change,the change of the serum BNP level,changes in left ventricular ejection fraction,the changes of serum sodium concentration and liver and kidney function further evaluation tolvaptan 's curative effect in patients with refractory heart failure.Methods: Selected in cardiology,the second hospital of hebei medical university of 60 patients with refractory heart failure(mean age,64.9±7.97 years)were randomly divided into experimental group 30 cases and control group 30 cases from may 2014 to December 2015,Control to conventional heart failure treatment,the experimental group in the control group on the basis of oral tolvaptan treatment,Observe two groups of patients with medication before and after 7 days of patients with dyspnea,lung rales,leg edema,and so on.Using 4 indexing method to assess breathing difficulties;4 indexing method to evaluate lung rales;4 indexing method to assess limb edema;Observe the 24 hours urine volume in patients with increased situation before and after the decrease of the quality of the seven celestial medication,And in the preparation before and after review the electrolytes,renal function and serum BNP in patients with 7 days.Results:1 In 60 cases of enrolled patients,according to random number,Table is divided into two groups,30 cases in each group,two groups in gender,age,heart failure in patients with primary cause and basis of left ventricular ejection fraction(LVEF),brain natriuretic peptide(BNP)and renal function in clinical data and compared difference has no statistical significance(P > 0.05),comparable.2 Compared with the control group,The common symptoms of heart failure patients' include dyspnea,lung's rale,leg edema,and so on were obviously improved after seven days' treatment of oral tolvaptan(P < 0.05).3 Compared with the control group,urine volume increased significantly after 24hours' treatment of oral tolvaptan in patients with heart failure,and body mass declined obviously than the control group after treatment 7days(P < 0.05).4 Both groups of patients after treatment,the serum BNP levels were comparable decreased(P < 0.05)than on admission to hospital and both left ventricular ejection fraction increased(P < 0.05),but the group of oral tolvaptan on decreasing serum BNP and left ventricular ejection fraction increased more significantly than control group(P < 0.05).5 The serum sodium concentration were increased(P < 0.05)of the two groups of patients after treatment,but oral tolvaptan group increased more obviously,(P < 0.05).6 Compared with the control group,serum creatinine in patients with no obvious rise,(P > 0.05).Show that tolvapton won't cause kidney disorders.7 To observe the adverse reaction of oral tolvapton group in hospitalization,we will find that excepted three people appear dry mouth,thirst phenomenon,not found hypotension,severe liver and kidney function damage situation,and not found the disease patients of permeability demyelinating because of the elevated serum sodium too rapidly.Conclusion:1 Tolvaptan can improve the signs and symptoms of refractory heart failure patients.2 Tolvaptan can increase the serum sodium concentration.3 There is no obvious adverse reactions in the kidney function in addition to cause dry mouth and Thirsty. |
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