托伐普坦治疗动脉瘤性蛛网膜下腔出血后低钠血症的临床疗效

摘要/Abstract

摘要： 目的评估托伐普坦治疗动脉瘤性蛛网膜下腔出血后低钠血症的有效性、安全性。方法选取2020年1月—2022年 6月航天中心医院收治的68例动脉瘤性蛛网膜下腔出血患者临床资料进行回顾性分析,按照患者的治疗方法进行分组,将采取高渗盐水治疗的35例患者分为高渗盐水组,将采取托伐普坦治疗的33例患者分为托伐普坦组,分析两组患者临床血钠水平变化及治疗情况、不同时间美国国立卫生研究院卒中量表（NIHSS）评分变化,并对比两组治疗过程中的不良反应发生情况。结果治疗前,两组患者血钠水平比较,差异无统计学意义（P>0.05）;治疗24 h后、出院时,两组患者血钠水平明显上升,且托伐普坦组明显高于高渗盐水组,差异有统计学意义（P<0.05）。托伐普坦组患者治疗24 h后需再次接受治疗与出院时低钠血症发生率明显低于高渗盐水组,差异有统计学意义（P<0.05）。治疗前,两组患者NIHSS评分比较,差异无统计学意义（P>0.05）;治疗24 h后,托伐普坦组NIHSS评分略低于高渗盐水组,差异无统计学意义（P>0.05）;治疗3 d后,托伐普坦组NIHSS评分明显低于高渗盐水组,差异具有统计学意义（P<0.05）,但两组患者出院时NIHSS评分比较,差异无统计学意义（P>0.05）。高渗盐水组1例患者血钠过快上升,干预后好转。两组患者不良反应发生率比较,差异无统计学意义（P>0.05）。结论采用托伐普坦治疗动脉瘤性蛛网膜下腔出血后低钠血症疗效显著,能显著提高患者血钠水平,同时减轻患者神经功能损伤,且安全性较高。

关键词: 托伐普坦, 动脉瘤性蛛网膜下腔出血, 低钠血症, 临床疗效, 安全性

Abstract: Objective To evaluate the efficacy and safety of tovaptan in the treatment of hyponatremia after aneurysmal subarachnoid hemorrhage. Methods 68 patients with aneurysmal subarachnoid hemorrhage admitted to our hospital from January 1, 2020 to June 30, 2022 were retrospectively analyzed. According to the treatment methods of patients, 35 patients who were treated with hypertonic saline were divided into hypertonic saline group, 33 patients who were treated with tolvaptan were divided into tolvaptan group. The clinical baseline data of the two groups, changes in blood sodium level and treatment, changes in NIHSS score at different times, and the comparison of adverse reactions in the course of treatment were analyzed. Results There was no significant difference in the blood sodium level between the two groups before treatment (P>0.05). The blood sodium level in the two groups increased significantly from 24 hours after treatment to discharge, but the level in the tolvaptan group was significantly higher than that in the hypertonic saline group. At the same time, the incidence of hyponatremia in the tolvaptan group at discharge and the need to receive treatment again 24 hours later was significantly lower than that in the hypertonic saline group (P<0.05); There was no difference in the NIHSS score between the two groups before treatment, and all time point after treatment. The 24-hour tolvarutan group was slightly lower than the hypertonic saline group (P>0.05), and 3 days was significantly lower than the tolvarutan group (P<0.05), but there was no difference between the two groups at discharge (P>0.05); one patient in the hypertonic saline group increased blood sodium too rapidly and improved after intervention. There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The treatment of hyponatremia after aneurysmal subarachnoid hemorrhage has a significant effect, which significantly reduced the blood sodium level of patients, and reduced the nerve damage of patients, with high safety.

Key words: tovaptan, aneurysmal subarachnoid hemorrhage, hyponatremia, clinical efficacy, security

中图分类号:

R969

赛音巴雅尔. 托伐普坦治疗动脉瘤性蛛网膜下腔出血后低钠血症的临床疗效[J]. 中华养生保健, 2023, 41(11): 44-47.

Saiyinbayaer. Clinical Efficacy of Tovaptan in Treating Hyponatremia after Aneurysmal Subarachnoid Hemorrhage[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(11): 44-47.

参考文献

[1] 薛晓丹,李威,张颖,等.1999-2018年天津市蛛网膜下腔出血的发病率及变化趋势研究[J].中华神经外科杂志,2021,37(8):798-804.
[2] 徐燕琳,陈振东,朱虹,等.合并抗利尿激素分泌不适当综合征和焦磷酸钙沉积的Gitelman综合征一例报道[J].中华急诊医学杂志,2021,30(6):758-760.
[3] 姬培培,伍艳春,张庆英,等.动脉瘤性蛛网膜下腔出血手术治疗后患者的不良预后因素评估[J].中国医药,2021,16(12):1813-1817.
[4] 马福慧,王新玲,王静,等.Gitelman综合征合并严重低钠血症的诊治分析[J].中国全科医学,2021,24(12):1556-1559.
[5] 施淑华,何道兴,林赛金.托伐普坦片治疗肝硬化腹水,低钠血症的效果及安全性[J].传染病信息,2021,34(3):246-249.
[6] 黄梦洁,闫静,叶玲,等.托伐普坦治疗心力衰竭合并低钠血症疗效的Meta分析[J].中国循证心血管医学杂志,2021,13(12):1413-1417,1429.
[7] 倪伟,宋剑平,顾宇翔,等.2012版美国动脉瘤性蛛网膜下腔出血治疗指南解读[J].中华神经外科杂志,2012,28(9):865-869.
[8] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组,中华医学会神经病学分会神经血管介入协作组.中国蛛网膜下腔出血诊治指南2019[J].中华神经科杂志,2019,52(12):1006-1021.
[9] 蔡业峰,贾真,张新春,等.美国国立卫生院卒中量表(NIHSS)中文版多中心测评研究——附537例缺血中风多中心多时点临床测评研究[J].北京中医药大学学报,2008,31(7):494-498.
[10] 刘林,李浩,汤善宏.肝肾综合征低钠血症的发病机制及临床诊治进展[J].胃肠病学和肝病学杂志,2022,31(5):594-597.
[11] 陈冬琳,邓晓兰,刘煜.伏立康唑致AML并发IFI患者低钾血症和低钠血症及其与伏立康唑谷浓度的相关性[J].医学综述,2021,27(13):2691-2694.
[12] 胡岚,李谦益,梁栋,等.创伤性脑损伤并发低钠血症的危险因素分析[J].临床急诊杂志,2020,21(7):572-580.
[13] 王振兴,陈志永,刘爽.颅脑损伤后并发低钠血症情况,临床特点及危险因素分析[J].临床误诊误治,2020,33(4):67-71.
[14] 王丽丽,耿传营,章艳茹,等.硼替佐米治疗多发性骨髓瘤诱发MAS样病变并引起SIADH3例报告并文献复习[J].中华血液学杂志,2022,43(1):75-77.
[15] HANNON M J, BEHAN L A, O’BRIEN M M, et al. Hyponatremia following mild/moderate subarachnoid hemorrhage is due to SIAD and glucocorticoid deficiency and not cerebral salt wasting[J]. J Clin Endocrinol Metab, 2014, 99(1):291-298.
[16] 张润萍. 托伐普坦治疗老年慢性心力衰竭合并低钠血症的疗效与安全性[J].中西医结合心脑血管病杂志,2021,19(10):1706-1708.
[17] 裴丽峰,韩英.托伐普坦在急性心肌梗死后心力衰竭合并低钠血症治疗中的疗效与安全性[J].药学服务与研究,2021,21(3):175-180.
[18] 陈晓雯,马瑶,马文珠,等.低剂量托伐普坦成功治疗老年冠心病合并顽固性低钠血症1例报道并相关文献复习[J].实用老年医学,2022,36(7):745-747.
[19] LLOMPART-POU J A, PÉREZ-BÁRCENA J, NOVO M, et al. Effect of single-dose of tolvaptan in neurocritical patients with hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion[J]. Med Intensiva,2017,41(8):501-503.