强化利尿并高张盐水在难治性心力衰竭伴低钠血症患者中的疗效观察

Effect of aggressive diuresis with hypertonic saline solution in refractory heart failure with hyponatremia

目的探讨强化利尿并高张盐水在伴有低钠血症的难治性心力衰竭患者中的疗效。方法收集难治性心力衰竭伴低钠血症患者21例,随机分为11例和10例两组,分别给予1.81%或2.72%高张盐水配合大剂量呋塞米静脉滴注和单纯大剂量呋塞米静脉使用,记录两组患者的心功能、尿量、体重及血钠等指标的变化。结果呋塞米并高张盐水组尿量、体重、血钠由治疗前的595ml/24h±163ml/24h、63.9kg±5.8kg和121.1mmol/L±7.3mmol/L变为治疗后的2186ml/24h±256ml/24h、54.2±4.8kg和137.1mmol/L±4.9mmol/L;在尿量增加、体重减轻、血钠恢复正常等方面明显优于单纯呋塞米组。NYHA心功能分级呋塞米并高张盐水组也显著优于单纯呋塞米组。结论难治性心力衰竭伴低钠血症患者使用高张盐水配合强化利尿可有效减轻水钠潴留,改善心脏功能,并有效纠正低钠血症。其机制可能与高张盐水增加有效循环血量,改善肾脏灌注,抑制神经内分泌激活,增加利尿剂在作用部位浓度等有关。

Objective To explore the effect of aggressive diuresis with hypertonic saline solution （HSS） on refractory heart failure （RHF） with hyponatremia. Methods Twenty-one patients were recruited and randomly divided into Group A and Group B. In Group A,the patients were treated with high dose of furosemide and 1.81% or 2.72% HSS;in Group B,the patients were treated by the same dose of furosemide only. Results The NYHA cardiac function, urinary volume, body weight, and serum sodium were recorded before and after treatment. In Group A, the urinary volume, body weight, and serum sodium changed from 595 ± 163ml/24hr,63.9 ± 5.8kg, 121.1 ± 7.3mmol/L to 2186 ± 256ml,54. 2 ± 4. 8kg, 137.1 ±4.9mmol/L respectively which were significantly better than those in Group B,the cardiac function improved significantly too. Conclusion Aggressive diuresis with HSS can decrease the volume overload,improve the cardiac function, resume the sodium concentration effectively than single aggressive diuresis ,the mechanisms perhaps involve in increasing effective eireulatory volume, improving renal bemedynamies,anti-neurohormone activation,and increasing the renal furosemide concentration.