Clinical Studies Of Hyponatremia In Moderate And Severe Patients With Heart Failure

Objective:This study collected general clinical data and biochemical data of patients with moderate-to-severe congestive heart failure with or without hyponatremia on the basis of standardized treatment of all patients with moderate-to-severe congestive heart failure,with moderate to severe heart failure with or without The patients with hyponatremia were followed up for 1 year and their prognosis was analyzed to provide a clinical basis for the recent assessment of prognosis in patients with congestive heart failure and hyponatremia.Method:A total of 77 consecutive patients with moderate-severe congestive heart failure who were admitted to Department of Cardiology,Second People's Hospital of Wuhu City from December 2015 to December 2016 were enrolled continuously.Immediately on admission,the patient's sex,age,past medical history,etc.were collected.Fasting blood of a patient when taking a vein or admission immediately acquired next morning sodium concentration,potassium concentration,chlorine concentration in the blood,blood urea nitrogen,creatinine,hemoglobin,amino-terminal atrial natriuretic peptide(NT-pro BNP)and the discharge index The index of urea nitrogen and serum creatinine was reviewed for the first 2±1 days;urine samples were collected for the morning urine samples on the next morning.On the next morning of admission,bedside color Doppler echocardiography obtained left ventricular end-diastolic dimension(LVDd)and left ventricular ejection fraction(LVEF)index.After discharge,the patient's history of drug use,total length of hospital stay,and exacerbation of renal function during hospital stay were summarized.And mortality during hospitalization and other data.According to the concentration of serum sodium in patients with normal serum sodium group(135mmol / L-145 mmol / L)a total of 30 cases(15 males and 15 females,mean age 67.90 ± 4.97 years),mild to moderate hyponatremia group There were 29 cases(15 males and 14 females,mean age 69.86 ± 4.53 years),severe hyponatremia group(<125mmol / L)(18 males and 8 females,There were 10 females with an average age of 68.78±4.13 years.Age,sex,serum potassium concentration,serum creatinine,serum creatinine,hemoglobin,NT-pro BNP,urinary specific gravity,left ventricular end diastolic diameter(LVDd)General clinical data such as left ventricular ejection fraction(LVEF);statistical analysis of total length of hospital stay,renal function deterioration rate during hospitalization,and mortality rate during hospitalization;death of patients with moderate to severe congestive heart failure Logistic regression analysis of factors;hospital survivors were followed up for 1 year outpatient or telephone,and their COX survival rate was analyzed for their survival time within 1 year.Results:Comparison between normal serum sodium group and mild-to-moderate hyponatremia group,age,gender,history of hypertension,history of diabetes,history of dyslipidemia,medication history,serum potassium concentration,blood chlorine concentration,urea nitrogen,serum creatinine,hemoglobin There were no significant differences in amino-terminal atrial natriuretic peptide(NT-pro BNP),urine specific gravity,left ventricular ejection fraction(LVEF),and left ventricular end-diastolic dimension(LVDd)(P>0.05).The difference was statistically significant(P <0.05).Comparison between normal serum sodium group and severe hyponatremia group,age,gender,history of hypertension,history of diabetes,history of dyslipidemia,medication history,serum potassium concentration,blood chlorine concentration,urea nitrogen,hemoglobin,urine specific gravity,left There was no significant difference in LVDd between the two groups(P> 0.05),but there was no significant difference in serum creatinine,NT-pro BNP,cardiac function classification and left ventricular ejection fraction(LVEF)The difference was statistically significant(P <0.05).Mild to moderate hyponatremia group and severe hyponatremia patients group,age,gender,history of hypertension,history of diabetes,history of dyslipidemia,medication history,serum potassium concentration,serum creatinine,blood urea nitrogen,hemoglobin,There was no significant difference in urine specific gravity,left ventricular end-diastolic dimension(LVDd),and left ventricular ejection fraction(LVEF)(P>0.05),but in serum creatinine and amino-terminal atrial natriuretic peptide(NT-pro BNP).There was significant difference in heart function grading(P <0.05).Logistic stepwise regression analysis of death factors in patients with moderate to severe heart failure suggests that serum sodium levels and amino-terminal atrial natriuretic peptide(NT-pro BNP)levels are associated with mortality in patients with moderate to severe heart failure;follow-up for 1 year Taking the survival time as the end point of clinical observation,the COX survival rate analysis suggested that compared with patients with moderate to severe heart failure and hyponatremia,the risk of death was lower in patients with moderate-severe heart failure and normal sodium concentrations than in patients with hyponatremia.HR=0.477,(95% CI: 0.256-0.889).Conclusion:1.Moderate to severe heart failure patients with hyponatremia often occur in the elderly population,and patients with blood sodium levels and serum creatinine,amino-terminal atrial natriuretic peptide(NT-pro BNP),left ventricular ejection fraction(LVEF)has Certain correlations;2.There is a certain correlation between serum sodium levels in patients with moderate to severe heart failure and total length of hospital stay,renal function deterioration rate,mortality rate in hospitalization,and hospital readmission rate within one year;3.Blood sodium level and Amino-terminal atrial natriuretic peptide(NT-pro BNP)is an independent risk factor for death in patients with moderate to severe heart failure within 1 year;4.Serum sodium concentration is an important predictor of recent survival in patients with moderate to severe heart failure.