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摘要：
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摘要：目的 探讨托伐普坦治疗伴低钠血症肝硬化腹水患者的临床疗效。方法 选取2013年10月至2017年
10月济南市传染病医院收治的124例伴低钠血症肝硬化腹水患者为研究对象，采用随机数字表法分为治
疗组（59例）和对照组（65例）。在常规综合治疗的基础上，治疗组患者给予托伐普坦15 mg/d，对照
组患者给予螺内酯400 mg/d、呋塞米160 mg/d，疗程均为5天。观察两组患者腹水体征的改善及治疗前
后肝功能、肾功能和生物化学指标的变化。结果 治疗后，治疗组患者24小时尿量显著高于对照组（t =
21.02，P = 0.0002），体重和腹围显著低于对照组（t值分别为14.06、12.59，P值均为0.02）。治疗后治
疗组患者血钠水平显著高于治疗前（t = 29.14，P = 0.002），两组患者治疗后血钠水平的差异有统计学
意义（t = 27.69，P = 0.003）。治疗组中39例（66.1%，39/59）患者治疗后血钠恢复正常或接近正常，对
照组中仅6例（0.09%，6/65）患者血钠恢复或接近正常，差异有统计学意义（χ 2 = 27.69，P = 0.003）。
结论 托伐普坦治疗伴低钠血症肝硬化腹水患者的疗效较好。
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Abstract: Objective To investigate the therapeutic effects of tolvaptan on patients of cirrhosis, ascites complicated
with hyponatremia. Methods Total of 124 patients of cirrhosis, ascites complicated with hyponatremia in Jinan
Infectious Disease Hospital from October 2013 to October 2017 were selected and divided into treatment group
(59 cases) and control group (65 cases) according to random digital table method. On the basis of conventional
comprehensive therapy, patients in treatment group were given torvalptan (15 mg/d) and patients in control
group were given spironolactone (400 mg/d) and furosemide (160 mg/d). The course of treatment was 5 days.
The improvement of ascites symptoms and the level of biochemical indexes before and after treatment were
observed. Results After treatment, 24-hour urine volume of patients in treatment group was significantly higher
than those in control group (t = 21.02，P = 0.0002), the body weight and circumference of abdomen were
significantly lower than those in control group (t = 14.06, 12.59; P = 0.02). After treatment, the serum sodium
level of patients in treatment group was significantly higher than that before treatment (t = 29.14, P = 0.002),
and the difference of blood sodium level between the two groups before and after treatment was statistically
significant (t = 27.69, P = 0.003). After treatment, the blood sodium level of 39 patients (66.1%, 39/59)
in treatment group and 6 patients (0.09%，6/65) in control group returned to normal or close to normal,
the difference was statistically significant (χ 2 = 27.69, P = 0.003). Conclusion Torvalptan is effective in the
treatment of patients of cirrhosis, ascites complicated with hyponatremia.
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