高渗盐水联合呋塞米治疗急性充血性心力衰竭：一项系统评价和荟萃分析。
Hypertonic saline with furosemide for the treatment of acute congestive heart failure: a systematic review and meta-analysis.
作者信息
Gandhi Sumeet, Mosleh Wassim, Myers Robert B H
机构信息
McMaster University, Division of Cardiology, Hamilton, ON, Canada; Sunnybrook Health Sciences Centre, Division of Cardiology, University of Toronto, ON, Canada.
Trinity College, Dublin, Ireland.
出版信息
Int J Cardiol. 2014 May 1;173(2):139-45. doi: 10.1016/j.ijcard.2014.03.020. Epub 2014 Mar 14.
BACKGROUND
Advanced congestive heart failure (CHF) therapies include intravenous inotropic agents, change in class of diuretics, and venous ultrafiltration or hemodialysis. These modalities have not been associated with improved prognosis and are limited by availability and cost. Compared to high-dose furosemide alone, concomitant hypertonic saline solution (HSS) administration has demonstrated improved clinical outcomes with good safety profile.
METHODS
A literature search was conducted for randomized controlled trials that investigated the use of HSS in patients admitted to hospital with acute CHF.
RESULTS
1032 patients treated with HSS and 1032 controls, demonstrated decreased all-cause mortality in patients treat with HSS with RR of 0.56 (95% CI 0.41-0.76,p=0.0003). 1012 patients treated with HSS and 1020 controls, demonstrated decreased heart failure hospital readmission with RR of 0.50 (95% CI 0.33-0.76,p=0.001). Patients treated with HSS also demonstrated decreased hospital length of stay (p=0.0002), greater weight loss (p<0.00001), and preservation of renal function (p<0.00001).
CONCLUSION
The results of this meta-analysis demonstrate that in patients with advanced CHF concomitant hypertonic saline administration improved weight loss, preserved renal function, and decreased length of hospitalization, mortality and heart failure rehospitalization. A future adequately powered, multi-centre, placebo controlled, randomized, double dummy, blinded trial is needed to assess the benefit of hypertonic saline in patients with renal dysfunction, in diverse patient populations, as well using a patient population on optimal current heart failure treatment. Pending further validation, there is promise for hypertonic saline as an advanced therapy for the management of acute advanced CHF.
背景
晚期充血性心力衰竭（CHF）的治疗方法包括静脉注射正性肌力药物、改变利尿剂类别以及静脉超滤或血液透析。这些治疗方式并未改善预后，且受到可用性和成本的限制。与单独使用大剂量呋塞米相比，同时给予高渗盐溶液（HSS）已显示出更好的临床结局且安全性良好。
方法
对调查HSS用于急性CHF住院患者的随机对照试验进行文献检索。
结果
1032例接受HSS治疗的患者和1032例对照者，接受HSS治疗的患者全因死亡率降低，相对危险度（RR）为0.56（95%置信区间[CI] 0.41 - 0.76，p = 0.0003）。1012例接受HSS治疗的患者和1020例对照者，显示心力衰竭再住院率降低，RR为0.50（95% CI 0.33 - 0.76，p = 0.001）。接受HSS治疗的患者还显示住院时间缩短（p = 0.0002）、体重减轻更多（p < 0.00001）以及肾功能得到保留（p < 0.00001）。
结论
这项荟萃分析的结果表明，在晚期CHF患者中，同时给予高渗盐可改善体重减轻、保留肾功能，并降低住院时间、死亡率和心力衰竭再住院率。未来需要进行一项有足够样本量、多中心、安慰剂对照、随机、双盲双模拟的试验，以评估高渗盐在肾功能不全患者、不同患者群体以及接受最佳当前心力衰竭治疗的患者群体中的益处。在进一步验证之前，高渗盐有望成为治疗急性晚期CHF的一种先进疗法。
Zotero 插件