心力衰竭病人入院时血钠水平与院内病死率的关系  

Correlation between Blood Sodium Level at Admission and Mortality in Patients with Heart Failure

作　　者：张川[1] 牟俊姣 ZHANG Chuan;MOU Junjiao(Fifth People′s Hospital of Chengdu,Chengdu 611130,Sichuan,China)

机构地区：[1]成都中医药大学附属第五人民医院/成都市第五人民医院,成都611130

出　　处：《中西医结合心脑血管病杂志》2023年第15期2807-2811,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的:分析入院时不同血钠水平的心力衰竭病人院内病死率及其相关危险因素。方法:采用回顾性队列研究的设计,连续选取2017年1月—2021年12月于我院重症医学科住院的心力衰竭病人734例作为研究对象。根据病人首次入院时的血钠水平分为低钠血症组(血钠<135 mmol/L,83例)、高钠血症组(血钠>145 mmol/L,23例)和正常血钠组(血钠135~145 mmol/L,628例)。收集病人的临床资料,计算院内病死率,比较不同入院血钠水平心力衰竭病人与院内病死率的关系,采用多因素Logistic回归分析筛选心力衰竭住院病人发生院内死亡的相关危险因素。结果:不同入院血钠水平心力衰竭病人的年龄、收缩压、纽约心脏病协会(NYHA)心功能分级、血肌酐、血清清蛋白、N末端B型利钠肽原(NT-proBNP)和住院天数比较,差异均有统计学意义(P<0.05)。734例住院心力衰竭病人中,院内病死率为5.2%,住院期间死亡的心力衰竭病人入院时血钠水平低于存活病人[(135.9±4.6)mmol/L与(139.8±3.9)mmol/L],差异有统计学意义(t=-5.126,P<0.001)。低钠血症组、高钠血症组及正常血钠组病人的院内病死率分别为14.5%、13.0%和3.7%,低钠血症和高钠血症病人的院内病死率均高于正常血钠组病人,差异有统计学意义(χ^(2)值分别为18.255,5.092,P<0.05)。多因素Logistic回归分析显示,入院时血钠水平是住院心力衰竭病人发生院内死亡的独立影响因素(P<0.001)。入院时血钠异常(OR=1.902)、低血钠症(OR=1.707)和高血钠症(OR=3.610)均为住院心力衰竭病人发生院内死亡的独立影响因素(P<0.05)。结论:入院时血钠水平异常,包括低钠血症和高钠血症,在心力衰竭病人中较为常见,其是住院心力衰竭病人发生院内死亡的独立危险因素。Objective:To analyze the relationship between in-hospital mortality of heart failure patients and levels of blood sodium,and explore the related risk factors.Methods:A total of 734 patients with heart failure were divided into hyponatremia group(sodium<135 mmol/L,83 cases),hypernatremia group(sodium>145 mmol/L,23 cases),and normal sodium group(sodium 135 to 145 mmol/L,628 cases)according to the blood sodium level at admission.The clinical data of patients were collected,the in-hospital mortality was calculated,and the relationship between blood sodium levels and in-hospital mortality was analysed.Multivariate Logistic regression analysis was used to screen the risk factors of in-hospital death in heart failure patients.Results:There were significant differences in age,systolic blood pressure,New York Heart Association(NYHA)cardiac function grade,creatinine,serum albumin,N-terminal B-type natriuretic peptide(NT-proBNP),and days of hospital stay among patients with different admission levels of blood sodium(P<0.05).The in-hospital fatality rate of 734 patients with heart failure was 5.2%.The blood sodium level of the patients with heart failure who died during hospitalization was significantly lower than that of the non-death patients,and the difference was statistically significant(t=-5.126,P<0.001).The in-hospital fatality rates in hyponatremia group,hypernatremia group and normal natremia group were 14.5%,13.0%and 3.7%,respectively.The in-hospital fatality rates in hyponatremia and hypernatremia patients were higher than those in normal natremia group.The difference was statistically significant(χ^(2) were 18.255 and 5.092,respectively,P<0.05).Multivariate Logistic regression analysis showed that blood sodium level at admission was an independent risk factor for in-hospital death in patients with heart failure(P<0.001).Abnormal blood natremia at admission(OR=1.902),hyponatremia(OR=1.707)and hypernatremia(OR=3.610)were independent risk factors for in-hospital death in patients with heart failure(P<0.05).Conclusi

关 键 词：心力衰竭 血清钠 院内病死率 危险因素 

分 类 号：R541.6[医药卫生—心血管疾病]