老年顽固性心力衰竭伴低钠血症的临床研究

目的探讨老年顽固性心力衰竭伴低钠血症的临床特点及治疗策略。方法回顾性分析2011年1月至2011年12月北京市和平里医院收治的74例60岁以上心功能Ⅲ^Ⅳ级心力衰竭患者的临床资料,其中合并低钠血症者59例,根据血钠水平分为血清钠正常组(135Ⅳ级心力衰竭患者的临床资料,其中合并低钠血症者59例,根据血钠水平分为血清钠正常组(135¹45 mmol/L)、轻度低钠血症组(130145 mmol/L)、轻度低钠血症组(130¹34 mmol/L)、中重度低钠血症组(中度120134 mmol/L)、中重度低钠血症组(中度120¹29 mmol/L、重度<120 mmol/L)三组。比较分析三组患者的临床特点及规范抗心力衰竭治疗+3%氯化钠静脉治疗的临床疗效。结果入院时合并低钠血症患者治疗后血钠水平显著升高,与治疗前比较差异有统计学意义(P<0.05);但三组患者平均住院日比较差异无统计学意义(P>0.05);中重度低钠血症组病死率较血清钠正常组高,差异有统计学意义(P<0.05);多因素回归分析显示:心功能分级为Ⅳ级和较长时间的血钠水平低与心力衰竭患者的病死率有密切联系。结论适度补充氯化钠可及时纠正老年顽固性心力衰竭合并的低钠血症,改善其预后。

Clinical Studies of Hyponatremia in Elderly Patients with Refractory Heart Failure

Objectlve To investigate the clinical features and treatment strategies of refractory heart failure in elderly patients with hyponatremia. Methods A retrospective analysis of the clinical data of 74 cases of Ⅲ-IV stage heart failure patients from Beijing Hepingli Hospital during Jan. 2011 and Dec. 2011 was done, including 59 cases combined with hyponatremia, according serum sodium levels they were divided into the normal sodium group（ 135-145 mmol/L）,mildly decreased serum sodium group（ 130-134 mmol/L） , moderate and severe decreased serum sodium group（ moderate 120-129 mmo]/L,and severe 〈 120 mmol/L）. Comparative analysis of the clinical characteristics of the three groups of patients with heart failure and clin- ical efficacy of standard anti-heart failure treatment ＋ 3% sodium chloride intravenous therapy treatment. Results Level of serum sodium of hyponatremia patients t the time of admission were significantly increased after treatment（ P 〈 0.05 ） ; but the average hospitalization of the three groups was not statistically significantly different（ P 〉 0.05 ） ;mortality of the moderate severe hyponatremia group was statistically sig- nificantly higher than the normal serum sodium group（ P 〈 0.05 ） ; multivariate regression analysis showed that heart function graded 1V and longer hyponatremia are closely linked with the mortality of heart failure. Conclusion Moderate sodium chloride, supplement may promptly correct hyponatremia in elderly patients with refractory heart failure, and improve the prognosis.