襻利尿剂对心力衰竭患者血钠的影响  

Impact of loop diuretics on blood sodium in patients hospitalized for heart failure

作　　者：管宇[1] 吴学思[1] 徐敏[1] 吴佳慧[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志》2014年第7期582-587,共6页Chinese Journal of Cardiology

摘　　要：目的：观察使用襻利尿剂前后心力衰竭（心衰）伴水潴留的患者血钠的变化，分析低钠血症的危险因素。方法对2008年10月至2013年1月就诊于北京安贞医院的1378例心衰失代偿期的患者进行筛选，最终入选满足使用襻利尿剂且体质量1周内减轻≥1 kg 的患者259例。按体质量减轻量分为A组（1 kg≤体质量减轻＜3 kg ）、B组（3 kg≤体质量减轻＜5 kg ）和C组（体质量减轻≥5 kg）。分析各组间基线资料是否有差异，及各组内血钠、血肌酐、尿素、尿酸变化情况及低钠血症发生的危险因素。结果 A组患者用药前后血钠无明显改变，B、C组患者则稍有降低，但仍在正常范围内。 B组患者血钠由（139.34±3.66） mmol/L降至（138.28±3.73） mmol/L（P＜0.05），C组患者血钠由（139.44±4.12） mmol/L降至（137.60±4.07） mmol/L（ P＜0.05）。46例（17.8％）患者发生低钠血症。入院前血钠正常的患者227例中，仅24例（10.5％）发生低钠血症。多因素logistic回归分析显示低钠血症的独立危险因子为利尿剂使用时间（OR＝1.191，95％CI 1.010～1.385）。结论襻利尿剂在明显改善水钠潴留的同时，安全性较好，低钠血症发生率较低，利尿剂使用时间为其低钠血症发生的独立危险因子。Objective To observe the level of blood sodium in patients hospitalized for heart failure with water-sodium retention treated with loop diuretics and risk factors of low blood sodium .Methods We selected 1 378 acute decompensated heart failure patients who visited Anzhen Hospital , and they are treated with loop diuretics , 259 patients with weight loses more than 1 kg in one week was enrolled in the final analysis, and divided into 3 groups：Group A （weight reduction between 1-3 kg）, Group B（weight reduction between 3-5 kg）and Group C（weight reduction over 5 kg）.Blood sodium, creatinine and uric acid were compared among groups and risk factors of low blood sodium were analyzed .Results Blood sodium was similar before and post loop diuretics treatment in Group A , and reduced in group B （ （138.28 ± 3.73） mmol/L vs.（139.34 ±3.66） mmol/L, P〈0.05） and in Group C（（137.60 ±4.07） mmol/L vs.（139.44 ±4.12 ） mmol/L, P 〈0.05 ）.Forty-six （ 17.8%） patients developed hyponatremia post loop diuretics treatment.Duration of loop diuretics use was the independent risk infector for hyponatremia （OR=1.191, 95%CI 1.010-1.385）.Conclusions Loop diuretics use is safe for treating hospitalized patients for heart failure with water-sodium retention and the risk of developing hyponatremia is low.Duration of loop diuretics use is the independent risk factor of hyponatremia .

关 键 词：心力衰竭 钠 利尿药 

分 类 号：R541.6[医药卫生—心血管疾病]