Study On The Effects Of Small-volume Hypertonic Saline Solution On The Management Of Patients With Heart Failure

ObjectivesTo observe RAAS hormones and NT-ProBNP changes in small volume hypertonic saline solution in treatment of refractory heart failure(RHF).MethodsFrom May.2010 to May.2011,33 patients(19 male and 14 female aged 72.7±11.6) with RHF were included in this study.33 inpatients with refractory heart failure were grouped into low blood pressure group and normotensive group, hyponatremia and normal serum sodium group, renal insufficiency and serum creatinine elevated group by blood pressure,serum sodium, serum creatinine values on admission.And to observe RAAS hormones and NT-ProBNP changes between the two groups. Secondly, to analysis the RAAS hormone and NT-ProBNP varies of 33 patients with refractory heart failure before and after treatment in patients with hypertonic saline solution. Thirdly, the correlation analysis of NT-ProBNP and Water and sodium retention, NT-ProBNP and jugular vein filling pressures were investigated.Results1)The variations of RAAS hormones, NT-ProBNP in blood pressure and normal blood pressure group:PRA, AngⅠ37℃, AngⅠ4℃, AngⅡ, Ald, NT-ProBNP value of the difference between blood pressure and normal blood pressure group was not significant (P >0.05).2)The variations of RAAS hormones, NT-ProBNP in normal renal function and serum creatinine elevated group:PRA,AngⅠ37℃,AngⅠ4℃in serum creatinine elevated group as significantly higher than in normal renal function group (P<0.01); AngⅡ,Ald,NT-ProBNP in serum creatinine elevated group was higher than in normal renal function group (P<0.05).3)The variations of RAAS hormones, NT-ProBNP in hyponatremia and normal serum sodium group:PRA,Ang I 37℃>AngⅡ>Ald,NT-ProBNP in hyponatremia group was higher than normal serum sodium group (P<0.05); AngⅠ4℃in hyponatremia group was significantly higher than normal serum sodium group (<0.01)4)The variations of RAAS hormones, NT-ProBNP between before and after management with HSS in patients with refractory heart failure:PRA,AngⅠ37℃,AngⅠ4℃,AngⅡ,Ald NT-ProBNP in after management with HSS was significantly lower than before(P<0.01). 5)The linear correlation between NT-ProBNP and jugular vein filling pressure,and NT-ProBNP and sodium retention score:NT-ProBNP and sodium retention score was positively correlated (P<0.05 r= 0.756); and jugular venous filling pressure was positively correlated (P<0.01 r= 0.790).ConclusionRHF with hypotension, hyponatremia, elevated serum creatinine, will further activate RAAS and the natriuretic peptide system, with RAAS hormone and NT-ProBNP significantly increased. Small-volume HSS management of RHF, the levels of RAAS hormones and NT-ProBNP can significantly reduce. NT-ProBNP and sodium retention scores, jugular vein filling pressure are good correlation, the level of NT-ProBNP by reaction of the body volume status and systemic pressure. There was a strong correlation between the level of NT-ProBNP and sodium retention scores, so was NT-ProBNP and jugular vein filling pressure.The sodium retention scores may react the body volume status and jugular vein filling pressure may react the systemic pressure to some extent.Key Words:Hypertonic salt solution; Refractory heart failure; Renin-angiotensin-aldosterone system; Brain natriuretic peptide; N-terminal pro-brain natriuretic peptide; Mechanism; Analysis of linear correlation. ObjectivesTo explore the safety and effectiveness of small volume hypertonic saline solution(HSS) in patients with refractory heart failure and acute heart failure(AHF) patients.MethodsTo observe the effect and safety of small-volumn HSS that was applied in patients with refractory heart failure and acute heart failure by a retrospective comparative study before and after their own. Comparison of the treatment of refractory heart failure in patients with HSS and the rencently last without HSS; Effect of high-dose furosemide and small-volumn HSS infusion in comparison with a high dose of furosemide in RHF,and so do patients with AHF.Results1) The comparison of symptoms and signs of congestion in the furosemide without HSS group and furosemide with HSS group:BW and sodium retention score in HSS group decreased than without HSS group in patients with refractory and acute heart failure (P<0.05); 24h urine in HSS group significantly increased than without HSS group in patients with refractory and acute heart failure; BP and HR were no statistically significant difference between HSS group and without HSS group in patients with RHF and AHF (P>0.05).2) The comparison of renal function,and electrolytes in the furosemide without HSS group and furosemide with HSS group:Serum creatinine in HSS group decreased than without HSS group in patients with RHF and AHF (P<0.05); Urea nitrogen and uric acid in HSS group had a downward trend than without HSS group, but no statistical significance (P> 0.05); Serum sodium in HSS group significantly increased than without HSS group in patients with RHF (P<0.01); Serum sodium and Serum chloride in HSS group increased than without HSS group in patients with AHF (P<0.01) 3) Comparison of hospital stay and hospital costs between the HSS groups and without HSS group in in patients with RHF and AHF. Shorter hospital stay (P<0.05), hospital costs spent less (P<0.01) in the HSS groups than without HSS group in patients with RHF and AHF.ConclusionSmall-volume HSS management is effective and well toleated in patients with RHA and AHA.,improves the quality of life and maintain cardiac function through the relief sign and symptoms of congestion, and protects renal function, with minor effect on electrolyte and acid-base balance disturbance and no adverse reaction, resulting the length of hospital stay and hospital costs were reduce.ObjectivesTo determine main risk factors of readmission in patients with Chronic heart failure(CHF).Methods1012 inpatients and outpatients with CHF were analyzed retrospectively by prospective cohort follow-up research methods, including history,demography,characteristics and after admission and other data of patients with CHF were obtained by medical review. After a single factor analysis, the risk of readmission in patients with CHF was analyzed and then multiple nonconditional logistic regression was used for potential confounding factors.ResultsIn our analysis, well-plan before discharge negatively correlated with readmission (OR=0.290 95%CI=0.197-0.425)。High salt diet and using salt solution during respiratory infection was positively correlated with readmission (ORA72=4.982 95%CI=3.562～6.969 ORA74=1.510 95%CI=1.128～2.023)ConclusionThe readmission in patients with CHF was common in our study, and high salt diet and using salt solution during respiratory infections are CHF patients risk factors for readmission, well-plan before discharge is CHF patients readmission protective factors.