内科

目的探讨托伐普坦治疗慢性心力衰竭（CHF）伴低钠血症患者的临床疗效以及对患者血清心肌肌钙蛋白（cTNT）水平等的影响。方法选取2018年3月至2020年3月在我院心内科住院治疗的CHF伴低钠血症患者95例，采用随机数字法分为观察组（48例）与对照组（47例）。对照组患者给予常规治疗；观察组患者在常规治疗的基础上给予托伐普坦治疗，连续治疗3个月。比较两组患者的临床治疗效果；比较两组患者治疗前后24小时尿量、体质量、血清cTNT水平、氨基末端B型尿钠肽前体（NT-proBNP）水平、钠离子水平以及心脏彩超检测结果的变化情况。结果观察组患者的治疗总有效率（89.58%）显著高于对照组（72.34%），差异有统计学意义（P＜0.05）。治疗前，两组患者的24小时尿量、体质量、cTNT水平、NT-proBNP水平、血清钠水平、左心室射血分数（LVEF）、左心室收缩末期内径（LVESd）、左心室舒张末期内径（LVEDd）比较，差异均无统计学意义（P＞0.05）。治疗3个月后，两组患者的24小时尿量、血清钠水平、LVEF水平均显著升高，观察组患者的水平显著高于对照组；两组患者的体质量、血清cTNT水平、血清NT-proBNP水平、LVESd水平、LVEDd水平均显著降低，观察组患者的水平显著低于对照组，差异有统计学（P＜0.05）。治疗期间，两组患者的不良反应发生率比较差异无统计学意义（P＞0.05）。结论在常规治疗的基础上，使用托伐普坦治疗CHF合并低钠血症患者，可显著提高临床疗效、改善心功能、减轻心肌损伤，但不增加不良反应。

ObjectiveTo explore the clinical efficacy of tolvaptan in the treatment of patients with chronic heart failure (CHF) complicated with hyponatremia and its effect on the levels of serum cardiac troponin (cTNT), etc. in patients. MethodsA total of 95 CHF patients complicated with hyponatremia who were hospitalized in the Cardiology Department of our hospital from March 2018 to March 2020 were selected, and they were divided into observation group (48 cases) and control group (47 cases) by the random number method. The control group was given conventional treatment, based on which the observation group was treated with tolvaptan, for a continuously three-month treatment. The clinical efficacy was compared between the two groups, and the changes of the 24h urine output, body mass, serum cTNT level, N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, sodium ion level, and the detective results of the cardiac color Doppler ultrasound before and after treatment were compared between the two groups. ResultsThe total effective rate of treatment in the observation group (89.58%) was significantly higher than that in the control group (72.34%), and the difference was statistically significant (P＜0.05). There were no statistically significant differences in 24h urine output, body mass, cTNT level, NT-proBNP level, serum sodium level, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESd), left ventricular end-diastolic diameter (LVEDd) before treatment between the two groups (P＞0.05). After 3 months of treatment, both groups obtained significantly higher levels of 24h urine output, serum sodium and LVEF, whereas significantly a lower body mass, lower levels of serum cTNT, serum NT-proBNP, LVESd and LVEDd; to compare with the control group, the observation group yielded higher levels of 24h urine output, serum sodium and LVEF, while a lower body mass, lower levels of serum cTNT, serum NT-proBNP, LVESd and LVEDd, with statistically significant differences (P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during the treatment period (P＞0.05). ConclusionEmploying tolvaptan in treating CHF complicated with hyponatremia based on the conventional treatment can significantly improve clinical efficacy, improve cardiac function, and reduce myocardial damage, but it does not increase adverse reactions.