目的探讨需大剂量使用利尿剂的严重慢性心力衰竭(CHF)患者住院期间低钠血症的预防及合并中重度低钠血症的补钠治疗.方法对入选的心功能III-IV级慢性心力衰竭住院患者随机分为限水组及限水+适当补盐组,对比两组患者一定时间后低钠血症的发生率.选择慢性心力衰竭合并中度低钠血症(120 mmol/L≤血钠≤125 mmol/L)的患者随机分为两组,一组为补充生理盐水组,另一组为补充高渗盐水组,对比观察两组低钠血症的治疗效果及风险.结果仅限水组低钠血症的发生率为13.4%,限水+适当补盐组低钠血症发生率为4.8%,两组比较差异有统计学意义(P <0.05).心衰合并中重度低钠血症患者治疗结果显示,等渗补钠组4 d低钠纠正率为48.4%,高渗补钠组4 d低纳纠正率为87.5%,两组比较差异有统计学意义(P<0.05),两组患者因心力衰竭无法纠正死亡或自动出院率分别为3.2%和3.6%,差异无统计学意义(P >0.05).结论严重CHF患者在限水的基础上给予适当补充一定量的钠盐有助于减少大剂量利尿剂引发低钠血症的发生率,对住院心力衰竭患者合并中重度低钠血症给予1.57%左右的高渗盐水在一定速度下(0.8 g/h)纠正低钠血症是有效且安全的.%Objective To explore the hospitalized serious congestive heart failure (CHF) patients' hyponatremia prevention and treatment of Moderate to severe hyponatremia. Methods The selected hospitalized patients of NYHA class III - IV chronic heart failure were randomly divided into two groups, water-restricting group and water-restricting+ fill salt group. Compare the incidence of hyponatremia between the two groups after a certain time: Choose chronic heart failure with moderate hyponatremia patients (I20mmol/L^serum sodium concentration≦ 125mmol/L), and they were also randomly divided into two groups, normal saline and hypertonic saline driping groups, Compare the effect and risk of hyponatremia treatment between the two groups. Results The hyponatremia incidence was 13.4% in water-restricting group,and 4.8% in water-restating + fill salt group,two rates were significantly different (P<0.05). After four days treatment, sodium correct rate was 48.4% in normal saline driping group and 87.5% in hypertonic saline driping group, two rates were quite significant differences (P<0.05), the two groups of patients for mortality and Deterioration rates were 3.2% and 3.6%, and there is no statistically significant differences (P>0.05). Conclusion CHF patients filling appropriate salt based on the Water-restricting helps to reduce the incidence of hyponatremia, for hospitalizedheart failure patients with moderate to severe hyponatremia,giving 1.57% about hypertonic saline driping in a certain speed (0.8 g/hour) is effective and safe for cidenceof hyponatremia
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