医源性低钠血症对慢性心力衰竭的预后价值

目的探讨慢性心力衰竭患者医源性低钠血症的预后价值。方法对2004年1月至2009年12月我院心内科入院资料完整的慢性心力衰竭患者进行回顾性分析,除外入院即刻血清钠离子浓度135mmol/L的患者,共786例,根据入院24h、48h血清钠离子浓度最低值分为三组:A组Na+≥135mmol/L;B组Na+120～135mmol/L;C组≤120mmol/L。比较各组心功能、血清钾离子浓度、住院病死率等指标。结果住院期间存活714例,死亡72例,存活组与死亡组血清钠离子浓度分别为(134.00±5.83)mmol/L和(121.00±7.15)mmol/L,差异有统计学意义(P0.01),而血清钾离子浓度分别为(4.4±0.6)mmol/L和(4.3±0.8)mmol/L,没有统计学差异(P0.05)。三组住院病死率分别为:A组7.8%(36/461),B组8.0%(23/289),C组36.1%(13/36),C组分别与A组和B组比较,均有统计学差异(P0.01)。结论医源性低钠血症是慢性心力衰竭患者预后不良的重要危险因素之一,应采取积极措施避免其发生。

The prognostic value of iatrogenic hyponatremia in patients with chronic heart failure

【Objective】To evaluate the prognostic significance of iatrogenic hyponatremia in patients with chronic heart failure（CHF）.【Methods】786 patients,with no hyponatremia on admission,with CHF were studied in our department of cardiology from Januuary 2004 to December 2009,The patients were divided into three groups according to serum sodium concentration within twenty four to forty-eight hours following the onset of CHF：Group A.Na ＋ ≥135mmol/L;Group B.Na^＋ 120-135mmol/L;Group C.Na^＋≤120mmol/L.The data of heart function,serum kalium concentration and inhospital mortality were analyzed retrospectively.【Results】714 casesof all recovered and 72 cases of all died in duration of hospital stay.Serum sodium concentration of recovered group（134.00 ± 5.83） mmol/L was significantly higher than that of the died group（121.00 ± 7.15） mmol/L（P〈 0.01）,with no significant difference in serum kalium concentration（P〉 0.05）.The inhospital mortality of each group：group A was 7.8%（36 /461）,group B was 8.0%（23 /289）,group C was 36.1%（13 /36）.The difference between group C and group B or group A was significant（P〈 0.01 for all）.【Conclusion】Iatrogenic hyponatremia is one of the important risk factors that predict a worse prognosis in patients with CHF,effective measures should be taken in clinical settings.