目的 探討托伐普坦治療老年重癥心力衰竭伴中重度低鈉血癥有效性和安全性研究。方法 選取2013年1月-2017年12月在空軍軍醫(yī)大學(xué)唐都醫(yī)院診治的老年重癥心力衰竭伴中重度低鈉血癥患者40例，隨機(jī)分為對(duì)照組（20例）和觀察組（20例），對(duì)照組患者采用常規(guī)方法治療，觀察組患者在常規(guī)方法的治療基礎(chǔ)上給予托伐普坦治療，連續(xù)治療7 d后比較兩組患者治療前后左室射血分?jǐn)?shù)（LVEF）、左室舒張末期壓力（LVEDP）、肺動(dòng)脈壓（PAP）、心輸出量（CO）、血鈉、血滲透壓及24 h尿量及不良反應(yīng)的發(fā)生率。結(jié)果 治療后，兩組患者的LVEF和CO顯著升高，而LVEDP和PAP顯著降低，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組患者的LVEF和CO顯著高于對(duì)照組，而LVEDP和PAP顯著低于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者的血鈉、血滲透壓及24 h尿量均明顯升高，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組患者的血鈉、血滲透壓及24 h尿量均顯著高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組患者不良反應(yīng)發(fā)生率為15.00%，對(duì)照組患者不良反應(yīng)發(fā)生率為25.00%，差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 托伐普坦治療老年重癥心力衰竭伴中重度低鈉血癥的臨床效果較好，可顯著改善患者的心功能及血鈉值，安全性較高。

Objective To investigate the effectiveness and safety of tolvaptan in the treatment of senile severe heart failure and moderate to severe hyponatremia.Methods 40 cases senile severe heart failure and moderate to severe hyponatremia patients from January 2013 to December 2017 in our hospital, random divided into control group (20 cases) and observation group (20 cases), the control group was given conventional method, the observation group was given conventional method based on the given tolvaptan treatment, compared with the left ventricular ejection fraction, left ventricular end diastolic pressure, pulmonary artery pressure, cardiac output, blood sodium, plasmaosmotic pressure and 24 h urine volume before and after treatment of the two groups, and the adverse reaction.Results Before treatment, compared with the LVEF, LVEDP, PAP, CO, blood sodium, plasmaosmotic pressure and 24 h urine volume of the two groups, the difference was not statistically significant. After treatment, compared with the control group, the LVEF and CO of the observation group significantly increased, but LVEDP and PAP significantly decreased, the difference was statistically significant (P<0.05). After treatment, compared with the control group, the blood sodium, plasmaosmotic pressure and 24 h urine volume of the observation group significantly increased, the difference was statistically significant (P<0.05); The incidence of adverse reaction of the observation group is three cases (15.00%), the incidence of adverse reaction of the control group is five cases (25.00%), the difference was not statistically significant.Conclusion Tolvaptan has good effect in the treatment of senile severe heart failure and moderate to severe hyponatremia, can significantly improved the cardiac function and blood sodium, the safety is high.