Objective To observe the therapeutic effect of low dose tolvaptan combined with furosemide in ederly patients with CHF and diuretic resistance (DR).Methods Eighty-five elderly patients with CHF and DR were divided into observation group (n=43) and control group (n=42).The patients in observation group were treated with cardiotonics and hypotensors plus oral tolvaptan (15 mg/d) combined with intravenous furosemide (40 mg/d).The therapeutic effect of low dose tolvaptan combined with furosemide was assessed.Results The average urinary volume was larger,and the LVEDV was significantly lower in two groups after treatment than before treatment (P＜0.05).The urinary volume was significantly larger while the LVEDV was significantly lower in observation group than in control group (2.89±0.87 L/d vs 2.43±0.49 L/d,P=0.01;103.6±21.5 ml vs 116.7±24.3 ml,P=0.01).The total effective rate was significantly higher in observation group than in control group (86.0％ vs 71.4％,P=0.01).Conclusion Low dose tolvaptan combined with furosemide can effectively improve the DR and therapeutic effect in elderly CHF patients,and is thus worth popularization in clinical practice.

Objective To analyze the relationship between onset of myocardial infarction(MI)to bivalent antibiotics therapy and outcome in elderly female MI patients.Methods One hundred and fourteen elderly MI patients admitted to our hospital from January 2016to January 2018were divided intoΔT≤188min group(n=57)andΔT＞188min group(n=57)according to the onset of MI to bivalent antibiotics therapy.The major adverse cardiac events(MACE),arrhythmia,angina pectoris,heart failure and death were compared between the two groups.Results MACE occurred in 44out of the 144MI patients included in this study.Of the 44MI patients,17died,6 were diagnosed with arrhythmia,16were diagnosed with angina pectoris,5were diagnosed with heart failure.The incidence of arrhythmia,heart failure and the mortality were significantly higher while the incidence of angina pectoris was significantly lower inΔT≤188min group than inΔT＞ 188min group(7.0％vs 3.5％,7.0％vs 1.8％,15.8％vs 14.0％,7.0％vs 21.1％,P＜0.05).Age,diabetes,ΔT,hyperlipidemia,hypertension and coronary artery disease were the independent influencing factors for the poor outcome in MI patients(P＜0.05,P＜0.01).Conclusion TheΔT should be shortened,the MI patients should be timely treated,the criminal blood vessels should be opened,and the ischemic myocardium should be saved in order to prevent the occurrence of severe cardiovascular events and reduce the mortality in elderly MI patients.