目的 探討托伐普坦片聯(lián)合注射用重組人腦利鈉肽治療頑固性心力衰竭的臨床療效。方法 選取2014年10月—2016年10月河北醫(yī)科大學(xué)第二醫(yī)院收治的頑固性心力衰竭患者128例，隨機(jī)分為對(duì)照組和治療組，每組各64例。對(duì)照組給予注射用重組人腦利鈉肽，靜脈推注1.5 μg/kg之后持續(xù)泵入7.5 ng/（kg·min），根據(jù)血壓情況調(diào)整劑量，治療3~5 d。治療組在對(duì)照組基礎(chǔ)上口服托伐普坦片，15 mg/次，1次/d，治療7 d。觀察兩組的臨床療效，比較兩組的臨床指標(biāo)和心功能指標(biāo)。結(jié)果 治療后，對(duì)照組和治療組的總有效率分別為70.3%、87.5%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P < 0.05）。治療后，兩組每日尿量、6 min步行距離明顯增加，血清氮末端腦鈉素原（NT-proBNP）、高敏C反應(yīng)蛋白（hs-CRP）水平顯著下降，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P < 0.05）；且治療組這些觀察指標(biāo)的改善程度明顯優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P < 0.05）。治療后，治療組血清鈉水平明顯升高，對(duì)照組血清鈉水平降低不明顯；治療后，治療組血清鈉明顯升高，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）。治療后，兩組左心室舒張末直徑（LVEDD）顯著下降，左心室射血分?jǐn)?shù)（LVEF）顯著升高，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P < 0.05）；且治療組LVEF的升高程度明顯高于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P < 0.05）。結(jié)論 托伐普坦片聯(lián)合注射用重組人腦利鈉肽治療頑固性心力衰竭具有較好的臨床療效，可改善臨床癥狀和心功能，糾正低鈉血癥，具有一定的臨床推廣應(yīng)用價(jià)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.