Holst Marie, Strömberg Anna, Lindholm Maud, Willenheimer Ronnie
Faculty of Health and Society, Malmö University and Department of Cardiology, Malmö University Hospital, Sweden.
J Clin Nurs. 2008 Sep;17(17):2318-26. doi: 10.1111/j.1365-2702.2008.02295.x.
To describe the self-reported fluid intake and its effects on body weight, signs and symptoms of heart failure, quality of life, physical capacity and thirst, in patients with stabilised chronic heart failure.
Patients with chronic heart failure are often recommended a fluid restriction of 1.5 l/day but there is no evidence in the literature for this recommendation and little is known about the fluid intake consequences.
Crossover study.
Chronic heart failure patients, clinically stabilised after an unstable state, were randomised to a 32-week cross-over study assessing the clinical importance of fluid prescription. In a secondary analysis of 63 patients, efficacy variables were analysed in relation to the self-reported median fluid intake of 19 ml/kg body weight/day.
The mean fluid intake was 16 ml/kg/day in the below-median group and 24 ml/kg/day in the above-median group. No between-group differences were found in change in body weight, signs and symptoms, diuretic use, quality of life or physical capacity. However, the above-median group significantly decreased sense of thirst and difficulties to adhere to the fluid prescription compared with the below-median group.
In clinically stabilised chronic heart failure patients on optimal pharmacological treatment, a larger fluid intake was associated with decreasing thirst without any measurable negative effects on signs and symptoms of heart failure, diuretic use or physical capacity. Thus, a more liberal fluid intake may be advisable in chronic heart failure patients who have been stabilised after an initial unstable clinical state.
Nurses involved in the care for patients with heart failure known how troublesome thirst can be and how difficult it can be to follow a restricted fluid intake. This study indicates that it is possible to reassess and recommend a less strict fluid intake in stabilised patients with chronic heart failure.
描述稳定期慢性心力衰竭患者自我报告的液体摄入量及其对体重、心力衰竭体征和症状、生活质量、身体能力及口渴感的影响。
慢性心力衰竭患者常被建议每日液体摄入量限制在1.5升，但文献中并无该建议的证据，且对液体摄入的后果知之甚少。
交叉研究。
处于不稳定状态后临床症状稳定的慢性心力衰竭患者被随机分配至一项为期32周的交叉研究，以评估液体处方的临床重要性。在对63例患者的二次分析中，分析了与自我报告的中位数每日19毫升/千克体重液体摄入量相关的疗效变量。
摄入量低于中位数组的平均液体摄入量为每日16毫升/千克，高于中位数组为每日24毫升/千克。两组在体重变化、体征和症状、利尿剂使用、生活质量或身体能力方面均未发现差异。然而，与摄入量低于中位数组相比，高于中位数组的口渴感显著降低，且遵守液体处方的难度降低。
在接受最佳药物治疗的临床症状稳定的慢性心力衰竭患者中，较多的液体摄入量与口渴感降低相关，且对心力衰竭体征和症状、利尿剂使用或身体能力无任何可测量的负面影响。因此，对于初始临床不稳定状态后已稳定的慢性心力衰竭患者，建议采用更宽松的液体摄入量。
参与心力衰竭患者护理的护士深知口渴有多麻烦，以及遵循液体摄入量限制有多困难。这项研究表明，对于临床症状稳定的慢性心力衰竭患者，可以重新评估并建议采用不太严格的液体摄入量。
