低钠血症对心力衰竭患儿预后的影响

Effect of hyponatremia on prognosis of heart failure in children

目的探讨低钠血症与心力衰竭患儿病情严重程度及预后的关系。方法回顾分析171例心力衰竭患儿的血清钠水平、临床特征及预后。结果171例患儿中男90例、女81例,平均年龄(3.0±1.1)岁。轻、中、重度心力衰竭患儿分别为72例、54例、45例。171例患儿中发生低钠血症103例(60.23%)。轻、中、重度心力衰竭患儿低钠血症的发生率分别为48.61%、55.56%、84.44%,差异有统计学意义(P<0.001);三组间血清钠水平的差异也有统计学意义(P<0.001),随心力衰竭程度逐步降低。轻、中、重度心力衰竭合并低钠血症患儿的病死率分别为2.86%、20.00%、71.05%,差异有统计学意义(P<0.001)。血清钠水平与心力衰竭严重程度之间存在显著负相关(r=-0.28,P<0.001)。经logistic回归分析发现,血钠水平越低(OR=0.16,95%CI:0.06~0.44),患儿死亡风险越大。结论低钠血症与心力衰竭患儿病情严重程度及预后密切相关。

Objectives To explore the relationship of hyponatremia with severity and prognosis of heart failure in children.Methods The serum sodium level, clinical characteristics and prognosis of heart failure in 171 children were analyzed retrospectively. Results In the 171 children (90 males, 81 females), an average age was 3.0±1.1 years. There were 72 cases of mild heart failure, 54 cases of moderate heart failure, and 45 cases of severe heart failure. Among 171 children, 103 (60.23%) had hyponatremia. The incidence of hyponatremia in children with mild, moderate and severe heart failure was 48.61%, 55.56% and 84.44% respectively The differences were statistically significant (P<0.001). The differences in serum sodium levels among the three groups were also statistically significant (P<0.001), and serum sodium levels gradually decreased with the aggravation of heart failure. The mortality of children with mild, moderate and severe heart failure complicated with hyponatremia was 2.86%, 20.00% and 71.05% respectively. The differences were statistically significant (P<0.001). There was a significant negative correlation between serum sodium level and the severity of heart failure (r=0.28, P<0.001). Logistic regression analysis showed that the risk of death was higher at lower level of serum sodium,(OR=0.16, 95%CI: 0.06~0.44). Conclusions Hyponatremia is closely related to the severity and prognosis of heart failure in children.