低钠血症对慢性心力衰竭住院患者预后影响的回顾性分析

摘要

目的 探讨入院时低钠血症对慢性心力衰竭(心衰)住院患者预后的影响. 方法对我院心脏科1980年1月至2007年8月2465例资料完整的心衰住院病例进行分析,按入院时血钠浓度分为低钠组(血钠<135 mmol/L)和非低钠组(血钠≥135 mmol/L),对并存低钠血症的心衰患者临床特点、治疗情况及低钠对预后的影响进行分析. 结果 2465例中,伴低钠血症者618例(25.1%),与非低钠组比较.低钠组人院时收缩压、左心窀射血分数均较低,血浆肾素活性、血管紧张素浓度及醛固酮浓度均较高.低钠血症患者较非低钠血症患者住院天数长(Z=-4.026,P<0.01),住院病死率亦高(χ2=76.935,P<0.01).多因素分析显示,入院时低钠血症是影响心衰患者住院天数和住院病死率的独立危险因素(分别为t=-4.135和χ2=25.473,均P<0.01),进一步分析结果显示,血钠与住院天数呈负相关(r=-0.132,P<0.01),入院时血钠每下降3 mmol/L,住院病死率增加24.7%χ2=25.065,P<0.01). 结论低钠血症在心衰患者中发生率较高,并存低钠血症的患者心功能差、神经激素活性高、住院天数长、住院病死率高.积极预防低钠血症发生对缩短心衰患者的住院时间和改善预后可能有益.%Objective To analyze the influence of hyponatremia on hospitalization days and hospital mortality of hospitalized patients with chronic heart failure. Methods All data were collected from 2465 patients with chronic heart failure in our hospital between January 1980 and August 2007. According to the admission serum sodium, all the patients were divided into two groups: low serum sodium group (Na+<135 mmol/L) and normal serum sodium group (Na+≥135retool/L). Clinical characteristics, therapeutic conditions and the influence of hyponatremia on prognosis were analyzed between the two groups. Results There were 618 patients in low serum sodium group among 2465 cases. Patients with hyponatremia were more likely to have lower systolic blood pressure and lower left ventricular ejection fraction. Lower admission serum sodium was related with higher concentration of serum angiotensin, aldosterone and higher activity of serum renin. Patients in low serum sodium group had significantly longer hospitalization days (Z=-4.026, P<0.01) and higher rate of hospital mortality (χ2=76.935, P<0.01) than patients in normal serum sodium group. Multivariate logistic regression indicated that lower admission serum sodium was an independent risk factor for hospitalization days (b= 0.928, P<0.01) and hospital mortality (OR=0.928, P<0.01). There was a negative correlation between admission serum sodium and hospitalization days (r=-0.132, P<0.01), and the rate of hospital mortality increased by 24.7for each 3 mmol/L decrease in admission serum sodium level. Conclusions Hyponatremia in hospitalized patients with chronic heart failure is relatively common and is associated with poorer heart function, higher activity of neural hormone and more severe prognosis. It is important to prevent hyponatremia for shortening hospitalization days and improving the prognosis of patients with chronic heart failure.