老年心力衰竭患者低钠血症与其预后相关性研究  

Correlation between hyponatremia and prognosis in elderly patients with heart failure

作　　者：姜伟伟 王海涛 JIANG Wei-wei;WANG Hai-tao(Department of Cardiology,970th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Yantai 264000,China)

机构地区：[1]中国人民解放军联勤保障部队第九七〇医院心内科,264000

出　　处：《中国实用医药》2023年第21期26-30,共5页China Practical Medicine

摘　　要：目的分析老年心力衰竭(心衰)患者低钠血症与其预后的相关性,旨意为相关人员的研究工作提供参考。方法80例60岁以上老年心衰患者,将入院时血钠值<135 mmol/L视为低钠血症,以此为基准,将患者分为非低钠组(44例)和低钠组(36例)。比较两组患者临床资料[基础疾病、美国纽约心脏病学会(NYHA)分级、收缩压(SBP)、舒张压(DBP)、心率、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、白蛋白、血红蛋白、血尿素、肌酐],血管紧张素、血浆肾素、醛固酮水平,用药详情,病死率以及住院时间;分析老年心衰患者病死率及住院时间的相关性。结果低钠组患者NYHA分级Ⅳ级23例、SBP 126(111,151)mm Hg(1 mm Hg=0.133 kPa)、DBP 78(71,81)mm Hg、LVEF 43(36,53)%、白蛋白37.1(33.6,40.1)g/L、血红蛋白128.6(113.2,142.5)g/L、血尿素7.9(5.6,11.4)mmol/L与非低钠组的18例、136(121,151)mm Hg、81(71,91)mm Hg、49(40,58)%、38.2(35.5,41.1)g/L、132.2(118.2,114.2)g/L、7.0(5.3,9.4)mmol/L比较,差异具有统计学意义(P<0.05);两组基础疾病、心率、LVEDD、肌酐水平比较,差异均无统计学意义(P>0.05)。低钠组血浆肾素1.02(0.36,4.36)μg/L、血管紧张素67.6(48.8,99.5)ng/L、醛固酮116.6(75.6,188.6)ng/L均高于非低钠组的0.43(0.11,1.38)μg/L、54.5(38.8,78.9)ng/L、97.6(68.6,141.5)ng/L,差异具有统计学意义(P<0.05)。非低钠组使用硝酸甘油酯类药物、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)药物、β-受体阻滞药物、钙通道阻滞药物占比分别为80.6%、61.1%、16.7%、16.7%,均低于非低钠组的95.5%、81.8%、38.6%、36.4%,使用洋地黄、利尿剂占比均为72.2%,均高于非低钠组的61.4%、59.1%,差异具有统计学意义(P<0.05)。所有患者的中位住院时间为13 d,全因病死率为11.25%(9/80)。非低钠组住院时间13(9,19)d短于低钠组的15(9,23)d,低钠组全因病死率为19.44%(7/36),高于非低钠组的4.55%(2/44),差异具有统计�Objective To analyze the correlation between hyponatremia and prognosis in elderly patients with heart failure,so as to provide reference for the research work of related personnel.Methods 80 elderly heart failure patients over 60 years of age were selected,the blood sodium value of<135 mmol/L at admission was considered as hyponatremia.Based on this,all patients were divided into non-hyponatremia group(44 cases)and hyponatremia group(36 cases).Both groups were compared in terms of clinical data[underlying disease,New York Heart Association(NYHA)grading,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate,left ventricular end-diastolic internal diameter(LVEDD),left ventricular ejection fraction(LVEF),albumin,hemoglobin,blood urea nitrogen,creatinine],angiotensin,plasma renin,aldosterone,details of medication use,mortality rate,and length of hospital stay.The correlation of mortality with length of hospital stay in elderly patients with heart failure was analyzed.Results In hyponatremia group,23 cases were in NYHA gradeⅣ,SBP was 126(111,151)mm Hg(1 mm Hg=0.133 kPa),DBP was 78(71,81)mm Hg,LVEF was 43(36,53)%,the albumin was 37.1(33.6,40.1)g/L,the hemoglobin was 128.6(113.2,142.5)g/L,the blood urea nitrogen was 7.9(5.6,11.4)mmol/L,which were lower than those of 18 cases,136(121,151)mm Hg,81(71,91)mm Hg,49(40,58)%,38.2(35.5,41.1)g/L,132.2(118.2,114.2)g/L,7.0(5.3,9.4)mmol/L in the non-hyponatremia group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in underlying diseases,heart rate,LVEDD and creatinine levels between the two groups(P>0.05).In hyponatremia group,the plasma renin was 1.02(0.36,4.36)μg/L,the angiotensin was 67.6(48.8,99.5)ng/L and the aldosterone was 116.6(75.6,188.6)ng/L,which were higher than those of 0.43(0.11,1.38)μg/L,54.5(38.8,78.9)ng/L and 97.6(68.6,141.5)ng/L in non-hyponatremia group,and the differences were statistically significant(P<0.05).The proportions of nitroglycerides,agiotensin converting enzyme inhibi

关 键 词：老年患者 心力衰竭 低钠血症 预后 相关性 

分 类 号：R541.6[医药卫生—心血管疾病]