There is significant evidence to show that many neurosurgical patients with hyponatremia, who were previously diagnosed with syndrome of inappropriate antidiuretic hormone secretion(SIADH), actually have cerebral salt...There is significant evidence to show that many neurosurgical patients with hyponatremia, who were previously diagnosed with syndrome of inappropriate antidiuretic hormone secretion(SIADH), actually have cerebral salt wasting syndrome(CSWS). The critical difference between SIADH and CSWS is that CSWS involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. The primary treatment for CSWS is water and salt replacement. The mechanisms underlying CSWS are not understood but may involve ANP or other natriuretic factors and direct neural influence on renal function.展开更多
目的:观察托伐普坦对伴有低钠血症的顽固性心力衰竭患者临床症状、心功能改善情况及血钠水平的影响。方法:选择2014-01至2015-10于我院心内科住院的伴有低钠血症的顽固性心力衰竭患者100例,随机分为托伐普坦组和对照组,各50例,两组患者...目的:观察托伐普坦对伴有低钠血症的顽固性心力衰竭患者临床症状、心功能改善情况及血钠水平的影响。方法:选择2014-01至2015-10于我院心内科住院的伴有低钠血症的顽固性心力衰竭患者100例,随机分为托伐普坦组和对照组,各50例,两组患者均给予常规强心、利尿、纠正离子紊乱治疗。托伐普坦组在常规治疗基础上加用托伐普坦15 mg/d,观察两组患者临床症状改善情况,心肾功能指标、离子水平的变化。结果:(1)托伐普坦组较对照组患者呼吸困难程度得到明显改善(P<0.01),肺部湿性啰音减少(P<0.05),双下肢水肿明显减轻(P<0.01)。托伐普坦组较对照组患者24 h尿量显著增加(ml,2 416.0±771.6 vs 1 124.6±215.7,P<0.01)N末端B型利钠肽原(NT-pro BNP)水平显著下降(pg/ml,2 678.04±537.09 vs 4 051.34±306.07,P<0.01);血钠水平显著升高(mmol/L,139.08±6.18 vs 129.44±2.20,P<0.01),差异均有统计学意义。(2)托伐普坦组有38例患者上述观察指标改善明显,用药1天后与用药前相比,血尿素氮水平即开始明显下降(mmol/L,7.28±1.53 vs 10.39±1.23,P<0.01);另外12例患者上述观察指标改善不明显,用药1天后与用药前比较,血尿素氮水平即开始显著升高(mmol/L,13.38±0.66 vs 10.39±1.23,P<0.01)。结论:托伐普坦能有效改善顽固性心力衰竭患者的临床症状、心功能状态,有助于提高血钠水平;可以通过早期尿素氮水平的变化评价托伐普坦的治疗效果。展开更多
文摘There is significant evidence to show that many neurosurgical patients with hyponatremia, who were previously diagnosed with syndrome of inappropriate antidiuretic hormone secretion(SIADH), actually have cerebral salt wasting syndrome(CSWS). The critical difference between SIADH and CSWS is that CSWS involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. The primary treatment for CSWS is water and salt replacement. The mechanisms underlying CSWS are not understood but may involve ANP or other natriuretic factors and direct neural influence on renal function.
文摘目的:观察托伐普坦对伴有低钠血症的顽固性心力衰竭患者临床症状、心功能改善情况及血钠水平的影响。方法:选择2014-01至2015-10于我院心内科住院的伴有低钠血症的顽固性心力衰竭患者100例,随机分为托伐普坦组和对照组,各50例,两组患者均给予常规强心、利尿、纠正离子紊乱治疗。托伐普坦组在常规治疗基础上加用托伐普坦15 mg/d,观察两组患者临床症状改善情况,心肾功能指标、离子水平的变化。结果:(1)托伐普坦组较对照组患者呼吸困难程度得到明显改善(P<0.01),肺部湿性啰音减少(P<0.05),双下肢水肿明显减轻(P<0.01)。托伐普坦组较对照组患者24 h尿量显著增加(ml,2 416.0±771.6 vs 1 124.6±215.7,P<0.01)N末端B型利钠肽原(NT-pro BNP)水平显著下降(pg/ml,2 678.04±537.09 vs 4 051.34±306.07,P<0.01);血钠水平显著升高(mmol/L,139.08±6.18 vs 129.44±2.20,P<0.01),差异均有统计学意义。(2)托伐普坦组有38例患者上述观察指标改善明显,用药1天后与用药前相比,血尿素氮水平即开始明显下降(mmol/L,7.28±1.53 vs 10.39±1.23,P<0.01);另外12例患者上述观察指标改善不明显,用药1天后与用药前比较,血尿素氮水平即开始显著升高(mmol/L,13.38±0.66 vs 10.39±1.23,P<0.01)。结论:托伐普坦能有效改善顽固性心力衰竭患者的临床症状、心功能状态,有助于提高血钠水平;可以通过早期尿素氮水平的变化评价托伐普坦的治疗效果。
