目的 探讨托伐普坦片联合注射用重组人脑利钠肽治疗顽固性心力衰竭的临床疗效。方法 选取2014年10月—2016年10月河北医科大学第二医院收治的顽固性心力衰竭患者128例，随机分为对照组和治疗组，每组各64例。对照组给予注射用重组人脑利钠肽，静脉推注1.5 μg/kg之后持续泵入7.5 ng/（kg·min），根据血压情况调整剂量，治疗3~5 d。治疗组在对照组基础上口服托伐普坦片，15 mg/次，1次/d，治疗7 d。观察两组的临床疗效，比较两组的临床指标和心功能指标。结果 治疗后，对照组和治疗组的总有效率分别为70.3%、87.5%，两组比较差异具有统计学意义（P < 0.05）。治疗后，两组每日尿量、6 min步行距离明显增加，血清氮末端脑钠素原（NT-proBNP）、高敏C反应蛋白（hs-CRP）水平显著下降，同组治疗前后比较差异具有统计学意义（P < 0.05）；且治疗组这些观察指标的改善程度明显优于对照组，两组比较差异具有统计学意义（P < 0.05）。治疗后，治疗组血清钠水平明显升高，对照组血清钠水平降低不明显；治疗后，治疗组血清钠明显升高，两组比较差异有统计学意义（P < 0.05）。治疗后，两组左心室舒张末直径（LVEDD）显著下降，左心室射血分数（LVEF）显著升高，同组治疗前后比较差异具有统计学意义（P < 0.05）；且治疗组LVEF的升高程度明显高于对照组，两组比较差异具有统计学意义（P < 0.05）。结论 托伐普坦片联合注射用重组人脑利钠肽治疗顽固性心力衰竭具有较好的临床疗效，可改善临床症状和心功能，纠正低钠血症，具有一定的临床推广应用价值。

Objective To explore the clinical effect of Tolvaptan Tablets combined with Recombinant Human Brain Natriuretic Peptide for injection in treatment of intractable heart failure. Methods Patients (128 cases) with intractable heart failure in the Second Hospital of Hebei Medical University from October 2014 to October 2016 were randomly divided into control and treatment groups, and each group had 64 cases. Patients in the control group were given Recombinant Human Brain Natriuretic Peptide for injection, continuous pumped into 7.5 ng/(kg·min) after intravenous injection of 1.5 μg/kg, adjusted the dose according to the condition of blood pressure, treated for 3 — 5 d. Patients in the treatment group were po administered with Tolvaptan Tablets on the basis of the control group, 15 mg/time, once daily, treated for 7 d. After treatment, the clinical efficacies were evaluated, and clinical indexes and cardiac function indexes in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 70.3% and 87.5%, respectively, and there was difference between two groups (P < 0.05). After treatment, daily urine volume and 6 min walking distance in two groups were significantly increased, but the levels of NT-proBNP and hs-CRP in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, serum sodium level in the treatment group was increased, but the level of serum in the control group was not obvious. After treatment, the serum sodium in the treatment group was significantly increased, and there was difference between two groups (P < 0.05). After treatment, LVEDD in two groups were significantly decreased, but LVEF in two groups were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And the LVEF in the treatment group were significantly higher than that in the control group, with significant difference between two groups (P < 0.05). Conclusion Tolvaptan Tablets combined with Recombinant Human Brain Natriuretic Peptide for injection has clinical curative effect in treatment of intractable heart failure, can improve clinical symptoms and cardiac function, and correct hyponatremia, which has a certain clinical application value.