88patientswithchronicheartfailurecombinedhyponatremiaclinicalfeaturesandprognosisofAnal

1、88 patients with chronic heart failurecombined hyponatremia clinical features andprognosis of AnalysisAbstractObjectiveToinvestigatetheclinicalmanifestationsofcongestiveheartfailure(CHFwithhyponatremiaandontheprognosisof88patientswithCHF with hyponatremia patients underwent heart failure,basictreatm

2、ent,andactivelycorrecthyponatremia,clinicalprognosisandtheresultsof266patients,theseverityofthe88cases(33.1%)patientswithhyponatremia,hyponatremiaandheart failure,severehyponatremia,highmortalityandpoorprognosis.Conclusiondiagnosisandtreatmentofheartfailureshouldattachgreat importancetotheoccurrence

3、andtreatmentofhyponatremia,hyponatremiacanincreasethe fatality rate, poor clinical outcome.Keywords:chronichyponatremiawithheartfailureprognosisHeartfailureis a varietyofcardiacstructural or functional disease causes impaired ventricular filling and ejection capacity (or) a group of1syndromes caused

4、 1. The occurrenceand developmentofchronicheartfailure(chronicheartfailure,CHF)isaslowthepathophysiologicalprocess,theendstageofheartdisease andheartfailurehas becomethemainreasonforhospitalizationof theelderly populationwiththedevelopmentoftheagingpopulationtrend, duetoeatingdisorders,neuroendocrin

5、edisorders,gastrointestinaldisorders,diuretics,excessiveuseoffactors such as often occurs in water and electrolyte andacid-basebalance disorders,especiallycommonishyponatremia, treatment of heart failure is more difficultnow hospital medical diagnosis and treatment of 88 casesofheartfailureto merget

6、headmissionofpatientswithhyponatremiaTheclinicalfeatures,serumsodiumconcentration and prognosis of outcome fora summaryanalysis.1Materialsand Methods1.1GeneralInformationMay2008toDecember2010,266patientswerediagnosedwithCHFhospitalized treatedpatients,readmission to the first admission serum sodium

7、prevail.Whichmergedwithhyponatremiagroupof88 cases2(33.1% hyperlipidemia,non-low-sodiumgroupof 178cases of hyponatremic group of 46 cases of male and 42female, aged 42 to 81 years old, average 63.8 + -9.8 yearsold. All patients had ECG, echocardiography, X-ray , bloodchemistry, electrolytediagnosis

8、of hyponatremicgroupand urinary sodium and urine specific gravity check.1.2 treatment: a cause of treatment, control ofthe conventional treatment of heart failure and eliminatepredisposingfactorinthetreatmentofhyponatremiagrouptreatment:serumsodium(120to 135)mmol/ L,oralsupplementationwithsalt, pick

9、ledvegetables(suchas salty mustard or appropriate to add saline, reduction orsuspension of diuretics, serum sodium less than 120mmol/ L, where appropriate, supplementary hypertonic 3% sodium chloride solution or isotonic saline, the serum sodium increased to 120mmol / L to 130mmol / L, then beapprop

10、riateto add saline or high-saltdiet,a courseoftreatmentbasedon specificconditions.serum sodium<115mmol/L, unresponsive,indifferentawarenessneuropsychiatric symptoms, then replenish the hypertonicsodium chloridesolution,sodiumchlorideweight(g)3according to the formula: (142mmol/L- measured ser

11、umsodium value)× 0.2× bodyweight(kg)/17 -Calculationofthedaytogivethecalculationoftheamountof1/4to 1/3,theremainingamountinaccordancewithreviewofserum sodiumandpatienttolerancedeterminesthe nextsodiumsupplementratemust be controlled, intravenous furosemide 20 40mgonce every35d.dilutionalhy

12、ponatremia,tolimittheamount of water-based water inflow <1000ml; such asconfusion,convulsionsandothersymptomsofcerebraledema, mannitol solution 100 200ml or hydrogenationof hydrocortisone100-200mgintravenousdripinfusionprocess plus with Cedilanid 0.2 mg of 0.4mg intravenouspotassium magnesium

13、 in the sodium, pay attention.1.3Clinicalobservationandfollow-upindicatorsMarkedly:theserumsodiumtorestorenormal cardiacfunctionimprovementof two or moreimproved:serumsodiumincrease orimprovementofcardiacfunctionin a: serumsodiumincreaseornoimprovementincardiacfunction,weight,ordeath.Observetheeffic

14、acyofhospitalstayandre-4hospitalization and follow-up of 1 year mortality.2Results88patientswithCHFwithhyponatremia, age <60 years old 29 cases, age> 60years, 59 cases (67.1% of which is the primary disease for20 cases of dilated cardiomyopathy, 19 cases of coronaryheartdisease,hyperte

15、nsiveheartdisease19cases, 17casesofpulmonaryheartdisease,9casesofrheumaticheart disease, congenital heart disease (n = 1), two casesof hypothyroidism,heartdisease,hyperthyroidheartdisease(n =1) inaccordancewith NewYorkHeartAssociation (NYHA) heart function. class standards, grade of 13 cases, 27 cas

16、es of grade, 48 cases of grade.Diagnosticcriteriaofhyponatremia,serumsodium concentration <135mmol / L, 121 134mmol /L, mildhyponatremia,110120mmol/ L for moderatelowsodium <110mmol / L, severehyponatremia, mildlow41cases ofsodium,moderatehyponatremiaof38cases,9 casesof severehyponatre

17、mia,fourcasesofasymptomatic,fatiguedoesnot28cases,nausea,vomiting 18 cases, edema, oliguria 28 cases, lethargy eight5cases, coma two cases.Based on clinical analysis, effective in 33 cases(37.5%,improvedin48cases(54.5%diedduringhospitalization7cases(7.95%,1-yearfollow-upreadmissionof 22 cases(25%dea

18、thin9 cases(10.2%,dilutional hyponatremia disease, 48 cases: effective in 17casesduringhospitalization,improvedin27 cases, 4patientsdied,1-year follow-uponceagainhospitalizedfor 10 cases, 4 patients died, 40 cases of lack of sodiumhyponatremiaduringhospitalizationwaseffectivein16cases,21casesimprove

19、d,Threepatientsdied,1-yearfollow-upreadmissionof12 cases,5 casesdied.ShareFree paper Download Center 3 discussionsChronic heart failure is the end stageheartdiseaseofvariouscausessodiumretentionandneural regulation of hormone activation is CHF the mostbasicfeatures.Heartfailure,decreasedcardiacoutpu

20、t,cardiac output can not meet the metabolism the need fororganandtissuebloodperfusionandpulmonarycirculationand(orsystemiccongestion,theclinicalmanifestationsofdyspneaandweaknessErzhilimited6physicalactivityandedemapresent,thepreventionandtreatment of heart failure has become Chinas major andgradual

21、 growth public health problem,althoughthetreatment of heart failure has been great progress, but themortality is still high, the high incidence of elderly age, theetiologyfordilatedcardiomyopathy,coronaryheartdisease,hypertensiveheartdiseasefromthe analysis ofthe etiologyofheart failurewithhyponatre

22、mia,DingXuesong2consideredthehighestincidenceofpulmonaryheartdiseasewithhyponatremiaandpulmonary heart disease accounted for the majority.Because heart failure patients with cardiac dropof blood, gastrointestinal tract congestion, loss of appetite,diet to reduce long-term, low-salt diet, diuretics u

23、se, andmayexisthypoproteinemiaa seriesofneurohumoralcompensatoryprocess,excessiveactivationofplasmarenin- angiotensin-aldosteronesystem(RAAS)andvasopressin secretion increases, causing the kidneys to thenatriureticweakened,sothatsodiumretentionincrease,promotetheformationofhyponatremiaandlowhypernat

24、remiafurtherlead totheactivationofplasma7RAAS, creating a vicious cycle. Therefore, in the treatmentofheartfailure,in additiontoimprovinghemodynamic,angiotensinconvertingenzymeinhibitors(ACEIorangiotensin receptor blocker ( the ARB), beta blockers andaldosterone receptor antagonists inhibit the RAAS

25、 activity,reducewaterand sodiumretentionis an importantwayfortheclinicaltreatmentofheartfailure.Xing-XiangWang 3 of hyponatremia rehydration salts, limited watertocorrecttheserumsodiumto normallevels,mptedtocorrecthyponatremia in CHF therapy to maintain ser

26、um sodiumbalance is very critical, with practice, appropriate sodiumsupplement,willenablethehyponatremiabe corrected,This can be avoided by hyponatremia, to avoid excessivediuretic-inducedhypovolemiacausedbyhypovolemichypotension.ofRAASissuppressed,heartfailure,mitigation, and to improve the prognos

27、is.At homeandabroadforheartfailurepatientsoverallemphasisonlow-saltdiet.Theconceptoftraditionaltreatment:patientswithsevereheartfailure,evenif thereis hyponatremia,norshouldbeaddedto8sodium chloride on the grounds that these patients waterretentionthansodiumretentionisdilutionalhyponatremia,themores

28、odiumsupplementthemoresevere the patient s symptoms,chronicheartfailureisoftenaccompaniedby gastrointestinalbleeding,lossofappetite, therefore, should not unduly limit the salt intakeshould bedeterminedaccordingtohyponatremiaandcardiac function amount of sodium intake and the rationaluseofdiuretics.

29、Diureticsareoneofthe importantmeasures for the treatment of patients with CHF, improperhandlingcause hydrolysisofmassdisorder,causedbyhyponatremia,actuallyworsenedheartfailure,theprognosisof CHFpatients.Therefore,theclinicalworkheartfailurepatients,particularlypatientswithCHFcannotabusediuretics,lon

30、g-termuseof diureticsinCHFpatientstomonitortheserumsodiumconcentration,whilepayingattentiontothespirit,mindsymptoms,topreventtheoccurrenceofhypotonicencephalopathy,hyponatremia CHF patients, reducing the mortality of CHFpatients.mergerhyponatremiainelderlyheartfailurepatients in the treatment of hea

31、rt failure at the same timetheamountofthesodium,bothtoimprovethe9short-term prognosis of the patients further treatmentfor the patient to secure and opportunity to improve theirlong-termprognosisandahigherincidenceofhyponatremia in patients with heart failure, and merger ofhyponatremiainpatientswithpoorcardiacfunction,neurohormonalactivity,hospitalizationandlong-termfollow-up(anaverageof 1yearmortality.activeprevention