充血性心力衰竭合并低钠血症56例临床分析

Clinical Analysis of Congestive Heart Failure Combined Hyponatremia in 56 Patients

目的分析充血性心力衰竭(CHF)合并低钠血症的诱因与治疗体会。方法选取我院收治的56例CHF心功能Ⅲ、Ⅳ级合并血钠<130mmol/L的患者临床资料进行分析。结果过度限盐和反复利尿是引起CHF合并低钠血症主要诱因,低钠血症分为缺钠性低钠血症和稀释性低钠血症,缺钠性低钠血症多见于心衰纠正后水肿减轻,稀释性低钠血症多见于心衰晚期,缺钠性低钠血症治疗效果优于稀释性低钠血症。结论 CHF患者不应盲目忌钠,须给予适量的钠摄入,并严密观察病情变化;在使用利尿剂治疗时应注意及时检查电解质,治疗低钠血症时首先应鉴别是缺钠性低钠血症还是稀释性低钠血症,缺钠性低钠血症治疗以补钠为主,稀释性低钠血症治疗以限水为主,所有患者必须同时纠正心衰治疗。

Objective To analyze incentives and treatment experience in congestive heart failure（CHF） combined hyponatremia.Methods Clinical data of 56 cases of patients with cardiac function of CHF Ⅲ,class Ⅳ merger serum sodium lower than 130 mmol/L admitted in our hospital was analyzed.Results Excessive salt restriction and repeated diuretic was caused by the CHF merger hyponatremia.The hyponatremia was divided into lack of sodium hyponatremia and dilutional hyponatremia.Lack of sodium hyponatremia was more common in heart decay corrected edema.Dilutional hyponatremia was more common in heart failure late.Lack of sodium hyponatremia treatment was better than dilutional h-yponatremia.Conclusions CHF patients should be given the right amount of sodium intaking and observed changes closely instead of avoid sodium blindly;They should be checkedelectrolyte when used diuretic.Lack of sodium hyponatremia and dilutional hyponatremia should be identified first before the treatment of hyponatremia.Supplement of sodium is the main treatment modality for lack of sodium hyponatremia,while water restriction is for dilutional hyponatremia.All patients must be corrected the heart failure in the same time.