目的 探讨托伐普坦治疗老年重症心力衰竭伴中重度低钠血症有效性和安全性研究。方法 选取2013年1月-2017年12月在空军军医大学唐都医院诊治的老年重症心力衰竭伴中重度低钠血症患者40例，随机分为对照组（20例）和观察组（20例），对照组患者采用常规方法治疗，观察组患者在常规方法的治疗基础上给予托伐普坦治疗，连续治疗7 d后比较两组患者治疗前后左室射血分数（LVEF）、左室舒张末期压力（LVEDP）、肺动脉压（PAP）、心输出量（CO）、血钠、血渗透压及24 h尿量及不良反应的发生率。结果 治疗后，两组患者的LVEF和CO显著升高，而LVEDP和PAP显著降低，差异具有统计学意义（P<0.05）；且观察组患者的LVEF和CO显著高于对照组，而LVEDP和PAP显著低于对照组，差异具有统计学意义（P<0.05）。治疗后，两组患者的血钠、血渗透压及24 h尿量均明显升高，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组患者的血钠、血渗透压及24 h尿量均显著高于对照组，差异具有统计学意义（P<0.05）。观察组患者不良反应发生率为15.00%，对照组患者不良反应发生率为25.00%，差异无统计学意义。结论 托伐普坦治疗老年重症心力衰竭伴中重度低钠血症的临床效果较好，可显著改善患者的心功能及血钠值，安全性较高。

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.