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慢性心力衰竭合并持续性低钠血症患者的特点

黄姣红1,王林1,马金萍1,李广平2   

  1. 1. 天津医科大学第二医院
    2. 天津医科大学第二医院心脏科
  • 收稿日期:2011-02-12 修回日期:2011-05-07 出版日期:2011-08-15 发布日期:2011-08-15
  • 通讯作者: 黄姣红

Retrospective Analysis of characteristics and prognosis of hopitalized Chronic Heart Failure patients with persistent hyponatremia

jiao-hong HUANG 2, 2, 2   

  • Received:2011-02-12 Revised:2011-05-07 Published:2011-08-15 Online:2011-08-15
  • Contact: jiao-hong HUANG

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摘要： 摘要 目的：分析慢性心力衰竭（心衰）持续性低钠血症患者的临床特点，探讨持续性低钠血症对预后的影响。方法：整理我院心脏科近30年因心衰急性发作而入院的病例，筛选入院时低钠患者，并根据出院时血钠将其分为持续性低钠组和恢复正常血钠组，对两组一般特点、治疗情况、住院天数和住院病死率进行比较。结果：入选452例，其中201（44.5%）例为持续性低钠，251（55.5%）例恢复正常血钠。持续性低钠患者入院时血钠、收缩压、左室射血分数、渗透压都较恢复正常血钠组低（分别为128.6mmol/L 与131.9 mmol/L,120mmHg与130 mmHg,39.0%与46.7%,285 Osm/kgH2O与291 Osm/kgH2O,均P＜0.05）。治疗方面，持续性低钠组利尿剂的使用比例较高，血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体拮抗剂使用比例较低。两组住院天数没有差别，持续性低钠组住院病死率高于恢复正常血钠组（χ2=22.383，P＜0.001）。多变量回归分析显示，持续性低钠血症是增加心衰患者住院病死率的独立危险因素（χ2=10.515，P=0.001），持续性低钠患者住院死亡风险比恢复正常血钠患者高2.534倍。结论：心衰合并持续性低钠血症患者临床表现较重、治疗效果差、住院病死率高，持续性低钠血症可能是住院病死率的独立危险因素。

关键词: 心力衰竭, 慢性, 低钠血症, 持续性, 治疗, 预后

Abstract: Retrospective Analysis of characteristics and prognosis of hopitalized Chronic Heart Failure patients with persistent hyponatremia HUANG Jiao-hong, WANG Lin△, MA Jin-ping, YANG Yan-hua,AN Fang, LI Guang-ping Department of Gerontology, the Second Hospital Affiliated to Tianjin Medical University, Tianjin 300211, China Abstract Objective:To analyze the clinical characteristics of hospitalized Chronic Heart Failure patients with persistent hyponatremia， research the influences of persistent hyponatremia to prognosis. Methods:Collecting cases with chronic heart failure and hyponatremia at admission during recent 30 years, categorizing appropriate cases into persistent hyponatremia group and normalized sodium group on the basis of serum sodium before leaving hospital. Comparing the general characteristics, drug therapy, days of hospitalization and in-hospital mortality between two groups. Results:452 cases were enrolled, among which there were 201(44.5%)cases being persistent hyponatremia,and 251(55.5%) being normalized serum sodium. Patients with persistent hyponatremia were characterized by lower admission sodium, lower systolic blood pressure, lower left ventricular ejection fraction and lower osmosis pressure(128.6mmol/L vs. 131.9 mmol/L,120mmgH vs. 130 mmgH,39.0% vs. 46.7%,285 Osm/kgH2O vs. 291 Osm/kgH2O,respectively.all P＜0.05).Among persistent hyponatremic patients, there were less patients receiving Angiotensin-converting enzyme inhibitors(ACEI) or Angiotensin receptor blocker(ARB),but more receiving diuretics. It was the same of hospital stays between two groups, whereas higher in-hospital mortality in persistent hyponatremic patients（χ2=22.383，P＜0.001）. After adjusting for differences with multivariable analysis, the risk of in-hospital mortality was increased by 2.534 folds in persistent hyponatremic patients compared with normalized patients（χ2=10.515，P=0.001）. Conclusion:Persistent hyponatremia in hospitalized patients with chronic heart failure is characterized by more severe symptoms, poorer responses to therapy and higher in-hospital mortality. Persistent hyponatremia was an independent risk factor of in-hospital mortality.

Key words: heart failure, chronic, hyponatremia, persistent, therapy, prognosis