| Objective:To observe the efficacy and safety of early combined with torasemide,tolvaptan and recombinant human brain natriuretic peptide(rh BNP)on acute heart failure(AHF).Methods:123 patients with AHF who met the inclusion criteria in the First Hospital of Shanxi Medical University between December 2016 and December 2017 were selected including 81 males and 42 females.They were divided into four groups: triple drug group,(group A),rh BNP combined with torsemide group(rh BNP group,group B),tolvaptan combined with torasemide group(Tolvaptan group,group C),torsemide group(group D),triple therapy group 38 cases,rh BNPgroup 25 cases,tolvaptan group 30 cases,torsemide group 30 cases.All patients were given basic treatment of heart failure.Group A was given torasemide 20 mg/d,and rh BNP treatment was continuously maintained at0.01 ?g/(kg · min)for 5 days and with tolvaptan 15mg/d.Group B was treated with torasemide 20mg/d;rh BNP usage and dosage were the same as triple therapy group.group C was given tolvaptan 15 mg/d and torasemide 20 mg/d,torasemide group was treated with torasemide 40 mg/d.All four groups were treated for 5 days.Observed the changes of indicators such as the symptoms of heart failure,blood routine,liver and kidney function,N-terminal pro-brain natriuretic peptide(NT-pro BNP),electrolyte,and net output at four groups.Results:1.After treatment,the symptoms of heart failure were significantly improved in the four groups.Compared with group D,the improvement rate of edema and pulmonary rales in group A,group B and group C was significantly increased(P<0.05).Compared with group A,the improvement rate of the symptoms of heart failure in group C and group B decreased significantly(P<0.05).The improvement rate of edema and pulmonary rales in group B was lower than that in group C(P>0.05).2.After treatment,the net output of patients in group A,B,C and D was higher than that before treatment,and the level of NT-pro BNP was lower than that before treatment(P<0.05).The comparison showed that the net output of group A,group B,group C and group D increased significantly(P<0.05);group A,group B,group C,D The NT-pro BNP of the patients was significantly decreased.There was no statistical difference between the B group and the C group(P>0.05),and the difference between the other two groups was statistically significant(P<0.05).3.After treatment,the levels of UA,Cys-C and creatinine in patients with group A and C decreased compared with those before treatment(P<0.05);the blood of patients in group B was treated with UA and Cys-C.The level was lower than that before treatment(P<0.05),and the serum creatinine level was slightly lower than that before treatment(P>0.05).The blood of patients in group D was treated with Cys-C and UA.The creatinine level was higher than that before treatment(P<0.05).After treatment,the comparison between the four groups of patients showed that there was no statistical difference between the two groups in group A,group B,group C and group D.(P>0.05);the difference between Cys-C and D in group A,B and C was statistically significant(P<0.05).There was no difference between Cys-C group in group A,B and C.Statistical significance(P>0.05);creatinine levels in group A,group B,and group C were significantly lower than those in group D(P<0.05),group A,group B,group C.The difference was not statistically significant(P>0.05).4.After treatment,the blood sodium levels of patients in group A and group C were higher than those before treatment(P<0.05).There was no significant difference between group A and group C before and after treatment(>0.05);the blood sodium and potassium levels in group B were slightly higher than those before treatment(P>0.05);the blood sodium level in group D was lower than that before treatment(P<0.05),serum potassium levels were slightly higher than before treatment(P>0.05).After treatment,the comparison between the four groups of patients showed that there was no significant difference in blood potassium levels between the four groups(P>0.05).The blood sodium levels in group B,group C and group A increased gradually,and the blood sodium level in group D decreased.There was no significant difference between group A and group C(P>0.05).The difference between the other two groups was statistically significant(P <0.05).After treatment,there was no significant difference in ALT and AST between the four groups(P>0.05).5.During the treatment,compared with group D,the hospitalization days of group A,group B and group C were gradually shortened(P<0.05).6.During the treatment period,2 patients in the tolvaptan group and the triple-agent group developed thirst symptoms,and the patient's thirst symptoms were relieved after appropriately increasing the amount of drinking water.Adverse reactions such as asymptomatic hypotension,hypernatremia,hyperkalemia,severe liver and kidney dysfunction.Conclusion:The early combination therapy with torsemide,tolvaptan and rh BNP is safe,and it can help significantly improve the symptoms of AHF,increase serum sodium levels,prevent acute renal injury,Shorten hospitalization days and improve prognosis. |
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