合并不同疾病的慢性心力衰竭患者电解质水平变化及意义
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摘要
目的探讨慢性心力衰竭(chronic heart failure,CHF)患者合并高血压、糖尿病、心房颤动等不同疾病时的电解质水平及其临床指导意义。方法选取2014年12月至2017年8月在徐州医科大学附属医院心内科住院治疗的CHF(非缺血性)心功能Ⅲ级的265例患者为研究对象,根据合并高血压、糖尿病、心房颤动等疾病情况分组,分别为未合并疾病组、合并单种疾病组、合并多种疾病组,合并单种疾病组划分为高血压组、糖尿病组、心房颤动组。合并多种疾病组分高血压+糖尿病组,高血压+心房颤动组,心房颤动+糖尿病组,高血压+糖尿病+心房颤动组,并记录各组患者入院第2天的电解质水平。结果 265例患者中有167例出现电解质紊乱,发生率为63.02%,其中单纯性低钠血症最常见,发生率为18.49%。未合并疾病组电解质紊乱发生率与高血压组、糖尿病组比较差异无显著性(P>0.05)。心房颤动组电解质紊乱发生率高于高血压组、糖尿病组,差异有显著性(P<0.05)。合并多种疾病组电解质紊乱发生率高于未合并疾病组、高血压组、糖尿病组,差异有显著性(P<0.05)。合并多种疾病组及各亚组电解质紊乱发生率均无明显差异(P>0.05),高血压+糖尿病+心房颤动组血清钾、钠均低于高血压+糖尿病组,高血压+心房颤动组血清钠低于高血压+糖尿病组,差异均有显著性(P<0.05)。结论 CHF患者合并不同疾病时,电解质紊乱发生率不同,其中合并心房颤动时电解质紊乱发生率较高;在未合并疾病或合并高血压、糖尿病等单种疾病时,电解质可维持相对稳定;但随着合并疾病增多(2种或以上时),对电解质的影响逐渐增大,更易发生电解质紊乱。
引文
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[15]刘铁成,刘恩照.心房利钠肽和转化生长因子β1在心房颤动心房纤维化进程中的作用及相互联系[J].中国循环杂志,2016,31(3):298-300.
[16]Hori M.Tolvaptan for the treatment of hyponatremia and hypervolemia in patients with congestive heart failure[J].Future Cardiol,2013,9(2):163-176.
[17]傅国胜.充血性心力衰竭和心房颤动[C]//浙江省医学会心血管病学会.2007年浙江省医学会心血管病学年会论文集,杭州.2007:27-29.
[2]Arrigo M,Truong QA,Onat D,et al.Soluble CD146 is a novel marker of systemic congestion in heart failure patients:an experimental mechanistic and transcardiac clinical study[J].Clin Chem,2017,63(1):386-393.
[3]Bui AL,Horwich TB.Epidemiology and risk profile of heart failure[J].Nat Rev Cardio,2011,8(1):30-41.
[4]Suzuki T,Israr MZ,Heaney LM,et al.Prognostic role of molecular forms of b-type natriuretic peptide in acute heart failure[J].Clin Chem,2017,63(4):880-886.
[5]徐淑清.心脉隆注射液治疗慢性心力衰竭合并电解质紊乱的临床效果[J].中国当代医药,2015(25):36-38.
[6]李晓丹,吴新华,陈章荣.慢性心力衰竭与低钙血症的研究进展[J].岭南心血管病杂志,2018,24(2):235-237.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[8]Gheorghiade M,Rossi JS,Cotts W,et al.Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE Trial[J].Arch Intern Med,2007,167(18):1998-2005.
[9]Rossi J,Bayram M,Udelson JE,et al.Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes:insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure(ACTIV in CHF)trial[J].Acute Card Care,2007,9(2):82-86.
[10]Wang J,Zhou W.Improvement of hyponatremia is associated with lower mortality risk in patients with acute decompensated heart failure:a meta-analysis of cohort studies[J].Heart Fail Rev,2018.[Epub ahead of print].
[11]Verbrugge FH,Steels P,Grieten L,et al.Hyponatremia in acute decompensated heart failure:depletion versus dilution[J].J Am Coll Cardiol,2015,65(5):480-492.
[12]王传合,刘双双,杨丽娜,等.低钠血症与慢性心力衰竭的相关性及预后分析[J].天津医药,2015,(10):1159-1161,1162.
[13]Willems R,Sipido KR,Holemans P,et al.Different patterns of angiotensinⅡand atrial natriuretic peptide secretion in a sheep model of atrial fibrillation[J].J Cardiovasc Electrophysiol,2001,12(12):1387-1392.
[14]Wozakowska-Kaplon B,Opolski G.No correlation between atrial natriuretic peptide concentrations and echocardiographic measurements of left atrial size or left ventricular size and function in patients with persistent atrial fibrillation[J].Pacing Clin Electrophysiol,2005,28:S110-S114.
[15]刘铁成,刘恩照.心房利钠肽和转化生长因子β1在心房颤动心房纤维化进程中的作用及相互联系[J].中国循环杂志,2016,31(3):298-300.
[16]Hori M.Tolvaptan for the treatment of hyponatremia and hypervolemia in patients with congestive heart failure[J].Future Cardiol,2013,9(2):163-176.
[17]傅国胜.充血性心力衰竭和心房颤动[C]//浙江省医学会心血管病学会.2007年浙江省医学会心血管病学年会论文集,杭州.2007:27-29.