目的 探討托伐普坦片聯(lián)合鹽酸多巴胺注射液和呋塞米注射液對(duì)頑固性心力衰竭患者心功能及各實(shí)驗(yàn)室指標(biāo)的影響。方法 選取延安大學(xué)附屬醫(yī)院2015年11月—2018年11月100例頑固性心力衰竭患者的臨床資料進(jìn)行回顧性研究，根據(jù)就診順序?qū)⑹茉囌叻纸M為對(duì)照組（50例）和觀察組（50例）。對(duì)照組患者將20 mg鹽酸多巴胺注射液加入到生理鹽水35 mL中靜脈泵入，滴速2 mL/h，1次/d，7 d為1療程。同時(shí)給予20～60 mL呋塞米注射液靜脈滴注，連續(xù)治療3 d。觀察組患者在對(duì)照組的基礎(chǔ)上口服托伐普坦片治療，1片/次，1次/d。連續(xù)治療7 d。比較兩組患者的治療總有效率、治療前后各心功能指標(biāo)、各血流動(dòng)力學(xué)指標(biāo)及N末端B型利鈉肽原（NT-proBNP）水平變化，以及用藥安全性。結(jié)果 治療后，觀察組治療總有效率為94.00%，對(duì)照組治療總有效率為74.00%，兩組比較存在統(tǒng)計(jì)學(xué)差異（P<0.05）。治療后，兩組患者左室收縮末期內(nèi)徑（LVESD）、左室舒張末期內(nèi)徑（LVEDD）較治療前顯著降低，左心射血分?jǐn)?shù)（LVEF）及6 min步行距離較治療前均顯著升高（P<0.05）；且觀察組以上指標(biāo)均顯著優(yōu)于對(duì)照組（P<0.05）。治療后，兩組患者每搏指數(shù)（SI）、速度指數(shù)（VI）、收縮壓（SBP）、心率（HR）、血鈉（Na⁺）、預(yù)射血期（PEP）、心臟指數(shù)（CI）、收縮時(shí)間比率（STR）、心輸出量（CO）、每搏輸出量（SV）及NT-proBNP水平較治療前均顯著改善（P<0.05），且觀察組血流動(dòng)力學(xué)指標(biāo)變化及NTproBNP水平顯著優(yōu)于對(duì)照組（P<0.05）。兩組不良反應(yīng)發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 托伐普坦片聯(lián)合鹽酸多巴胺注射液和呋塞米注射液可有效改善患者的心功能、各血流動(dòng)力學(xué)指標(biāo)及NT-proBNP水平，療效安全顯著，值得在頑固性心力衰竭治療中應(yīng)用推廣。

Objective To explore effect of Tolvaptan Tablets combined with Dopamine Hydrochloride Injection and Furosemide Injection on cardiac function and laboratory parameters in patients with refractory heart failure. Methods A total of 100 patients with refractory heart failure were selected as clinical information and conducted retrospective study from November 2015 to November 2018. According to the order of visits, subjects were divided into control group (50 cases) and observation group (50 cases). Patients in the control group pumped Dopamine Hydrochloride Injection, 20 mg was added to 35 mL normal saline at a drip rate of 2 mL/h, once daily, for a course of 7 d. At the same time, 20 — 60 mL Furosemide Injection was given intravenously for 3 d. Patients in the observation group were treated with Tolvaptan Tablets orally on the basis of the control group, 1 tablet/time, once daily, and continuous treatment for 7 d. Total effective rate of treatment, cardiac function indicators before and after treatment, changes in hemodynamic parameters and NT-proBNP levels, and medication safety in two groups were compared. Results After treatment, the total effective rate was 94.00% in the observation group, and 74.00% in the control group, and there was a statistical difference between two groups (P < 0.05). After treatment, the LVESD and LVEDD levels in two groups were significantly decreased, but the LVEF and 6 min walking distance were increased (P < 0.05), and the cardiac function indexes in the observation group was significantly better than those in the control group (P < 0.05). After treatment, the levels of SI, VI, SBP, HR, serum Na⁺, PEP, CI, STR, CO, SV, and NT-proBNP in two groups were significantly improved than those before treatment (P < 0.05), and the hemodynamic parameters and NT-proBNP levels in the observation group were significantly better than those in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between two groups.

R972

陜西省衛(wèi)生廳項(xiàng)目（SX13004023）