急性心力衰竭患者阶梯式药物和超滤治疗对血清钠水平的影响

Effect of stepped pharmacologic therapy and ultrafiltration on the serum sodium in patients with acute heart failure

目的:比较梯式药物和超滤治疗对急性心力衰竭患者血清钠水平的影响,及血清钠水平与出院后不良事件发生率的相关性。方法:本研究为前瞻性随机对照试验。将合并有肾功能恶化的162例急性失代偿性心力衰竭患者按1∶1比例随机纳入药物治疗组和超滤治疗组,分别给予利尿剂和超滤治疗,比较两组患者的血清钠水平其与血清肌酐、血浆肾素活性的相关性。结果:在基线及治疗的第1天,两组平均血清钠水平无统计学差异。分组治疗后的第2~7天,超滤治疗组的血清钠水平较药物治疗组明显降低,差异有统计学意义(P<0.05)。出院后的第30、60天,两组血清钠水平无显著差异。此外,超滤治疗组血清钠水平与血清肌酐和血浆肾素活性呈明显的负相关,药物治疗组三者的变化相对稳定。结论:与利尿剂治疗相比,通过超滤降低血容量更容易导致血钠水平的下降,但血钠水平可在第30天恢复至基线水平。持续性低钠血症而不是治疗导致的低钠血症与出院后不良事件相关。

Objective:To compare the effects of stepped pharmacologic therapy and ultrafiltration on serum sodium levels in patients with acute heart failure and the correlation between serum sodium levels and the incidence of adverse events after discharge.Method:This study was a prospective randomized controlled trial.A total of 162 patients with acute decompensated heart failure who were complicated with renal deterioration were randomly assigned to the stepped pharmacologic therapy and ultrafiltration treatment group in a 1∶1 ratio.The serum sodium levels of the two groups were compared and then the correlation between serum sodium levels and serum creatinine and plasma renin activity were analyzed.Result:There was no statistically significant difference in mean serum sodium levels between the two groups at baseline and the first day of treatment.Serum sodium levels in the ultrafiltration group were significantly lower than those in the stepped pharmacologic therapy group from second day to seventh day after therapy(all P<0.05).There was no significant difference in serum sodium levels 30 and 60 days after discharge between the two groups.In addition,in the ultrafiltration group,serum sodium levels were significantly negatively correlated with serum creatinine and plasma renin activity,and the changes in the stepped pharmacologic therapy group were relatively stable.Conclusion:Compared with stepped pharmacologic therapy,hypotensive blood volume reduced by ultrafiltration is more likely to lead to a decrease in serum sodium levels,but it can be returned to baseline levels on the 30 th day.Persistent hyponatremia,rather than treatment-induced hyponatremia,is associated with post-discharge adverse events.