重症心力衰竭伴低钠血症临床防治经验

Clinical experience of supplying sodium chloride for the treatment of patients with severe heartfailure

目的 观察适度补充氯化钠在重症心力衰竭治疗中的作用和安全性。方法回顾性分析了51例重症心力衰竭患者，在控制液体入量、使用袢利尿剂并规范应用其他重症心力衰竭药物治疗及病因治疗的基础上，采用普通饮食（非低盐饮食），食用咸菜，及3％氯化钠10ml／h持续静脉泵入的方法补充血钠浓度至正常范围低限。分析了入院2周内低钠血症发生率，适度补充氯化钠对心力衰竭治疗过程的影响及住院期间的预后。结果 入院时，低钠血症发生率37．25％（19／51），住院期间静脉利尿剂使用率88．24％（45／51）。2周内，低钠血症发生率64．71％（33／51），用适度补充氯化钠的方法纠正低钠血症，未发生因低钠血症导致的利尿剂抵抗，也未发生因适度补充氯化钠而心力衰竭加重或高钠血症。不合并、合并轻度或中重度低钠血症的三组重症心力衰竭患者的住院时间差异无统计学意义（P〉0．05），平均住院（16．1±11．7）d。51例住院患者中50例患者病情好转出院。结论 适度补充氯化钠可及时纠正重症心力衰竭患者合并的低钠血症，改善其住院预后。

Objective To observe the effect and safety of supplying sodium chloride in the treatment of patients with severe heart failure. Methods Consecutive 51 hospitalized patients with severe heart failure and cardiac edema were included in this study. Normal diet （6 g NaC1/d） was supplied to all patients. On the basis of controlling fluid intake and treating related etiological factors as well as standard medications including furosemide for severe heart failure, patients with mild hyponatremia （ serum sodium level 130- 134 mmoL/L） ate additional salted vegetables, patients with moderate hyponatremia （serum sodium level 125 - 129 mmol/L） and severe hyponatremia （serum sodium level 〈 125 mmol/L） ate additional salted vegetables and were received additionally intravenous 3% NaC1 hypertonic saline infusion （ 10 mL/h） until reaching normal serum sodium level. Results On admission, 37.25% （ 19/51 ） patients had hyponatremia. During the first two weeks hospitalization period, 88. 24% （45/51） patients were treated with intravenous diuretics and total incidence of hyponatremia was 64. 71% （33/51） , mild hyponatremia was 50. 98% （26/51） ,middle and severe hyponatremia was 13.73% （7/51） ; among them, hyponatremia lasted less than 3 d in 57.58% （ 19/33 ） patients and 〉/3 d in 42.42% （ 14/33 ） patients. Heart failure exacerbation and hyperuatremia were not observed in patients receiving additional sodium chloride therapy. Hospitalization time was similar among patients with different blood natrium levels [ average （16 ± 12 ） d]. Fifty out of 51 （98%） patients discharged from the hospital with improved heart failure symptoms and signs. Conclusion Supplying additional sodium chloride could rapid correct hyponatremia in heart failure patients with or without intravenous diuretics therapy which might contribute to a favorable prognosis in hospitalized heart failure patients.