Department of Cardiothoracic Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, People's Republic of China.
Braz J Cardiovasc Surg. 2024 Nov 28;e20230507(e20230507):e20230507. doi: 10.21470/1678-9741-2023-0507.
Globally, cardiovascular diseases remain a predominant cause of mortality. Effective fluid management is particularly critical in older adults undergoing cardiac surgery, due to their heightened risk of postoperative complications. Tolvaptan, an oral vasopressin V2 receptor antagonist, has emerged as a promising agent for fluid regulation in cardiac patients. However, its efficacy in the elderly undergoing cardiac surgery is not thoroughly evaluated.
This single-center retrospective analysis included 146 older adults (≥ 65 years) who underwent cardiac surgery between January 2018 and December 2022. Patients were categorized into two groups: those receiving tolvaptan and a control group receiving traditional diuretics post-surgery. We assessed several outcomes, including hospital length of stay, 30-day mortality, postoperative renal function, and complications.
The study found a significantly reduced hospitalization duration in the tolvaptan group (P=0.044), with no escalation in adverse events. The tolvaptan cohort exhibited a considerable increase in urine output on the postoperative day (POD) three (P=0.003), indicating enhanced renal function and fluid management. Serum creatinine levels notably declined by POD3 (P=0.012), and blood urea nitrogen levels were appreciably lower by POD5 (P<0.001) in the tolvaptan group. Furthermore, serum sodium levels significantly escalated on POD3 and POD5 (P<0.01) in this group, while serum potassium levels remained unchanged.
Tolvaptan significantly optimizes postoperative fluid management in older adults undergoing cardiac surgery. Its administration is linked to improved renal function and a shortened hospital stay, without amplifying adverse effects. These insights could enhance clinical practices and facilitate the management of fluid overload in this vulnerable demographic.
在全球范围内，心血管疾病仍然是主要的死亡原因。由于老年人心血管手术后并发症风险较高，有效的液体管理尤为关键。托伐普坦是一种口服血管加压素 V2 受体拮抗剂，已成为心脏疾病患者液体调节的一种有前途的药物。然而，其在老年心脏手术患者中的疗效尚未得到充分评估。
本单中心回顾性分析纳入了 146 名（≥65 岁）接受心脏手术的老年患者，手术时间为 2018 年 1 月至 2022 年 12 月。患者分为托伐普坦组和术后使用传统利尿剂的对照组。我们评估了包括住院时间、30 天死亡率、术后肾功能和并发症在内的多种结局。
研究发现托伐普坦组的住院时间明显缩短（P=0.044），且不良事件无增加。托伐普坦组术后第 3 天（P=0.003）的尿量明显增加，表明肾功能和液体管理得到改善。术后第 3 天（P=0.012）和第 5 天（P<0.001）托伐普坦组的血清肌酐水平显著下降，血尿素氮水平明显降低。此外，托伐普坦组术后第 3 天和第 5 天（P<0.01）血清钠水平显著升高，而血清钾水平保持不变。
托伐普坦显著优化了老年心脏手术患者的术后液体管理。它的使用与改善肾功能和缩短住院时间有关，而不会增加不良反应。这些发现可以提高临床实践水平，促进对这一脆弱人群液体超负荷的管理。
