目的 探讨托伐普坦片联合盐酸多巴胺注射液和呋塞米注射液对顽固性心力衰竭患者心功能及各实验室指标的影响。方法 选取延安大学附属医院2015年11月—2018年11月100例顽固性心力衰竭患者的临床资料进行回顾性研究，根据就诊顺序将受试者分组为对照组（50例）和观察组（50例）。对照组患者将20 mg盐酸多巴胺注射液加入到生理盐水35 mL中静脉泵入，滴速2 mL/h，1次/d，7 d为1疗程。同时给予20～60 mL呋塞米注射液静脉滴注，连续治疗3 d。观察组患者在对照组的基础上口服托伐普坦片治疗，1片/次，1次/d。连续治疗7 d。比较两组患者的治疗总有效率、治疗前后各心功能指标、各血流动力学指标及N末端B型利钠肽原（NT-proBNP）水平变化，以及用药安全性。结果 治疗后，观察组治疗总有效率为94.00%，对照组治疗总有效率为74.00%，两组比较存在统计学差异（P<0.05）。治疗后，两组患者左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）较治疗前显著降低，左心射血分数（LVEF）及6 min步行距离较治疗前均显著升高（P<0.05）；且观察组以上指标均显著优于对照组（P<0.05）。治疗后，两组患者每搏指数（SI）、速度指数（VI）、收缩压（SBP）、心率（HR）、血钠（Na⁺）、预射血期（PEP）、心脏指数（CI）、收缩时间比率（STR）、心输出量（CO）、每搏输出量（SV）及NT-proBNP水平较治疗前均显著改善（P<0.05），且观察组血流动力学指标变化及NTproBNP水平显著优于对照组（P<0.05）。两组不良反应发生率比较差异无统计学意义。结论 托伐普坦片联合盐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、各血流动力学指标及NT-proBNP水平，疗效安全显著，值得在顽固性心力衰竭治疗中应用推广。

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

陕西省卫生厅项目（SX13004023）