Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
JACC Heart Fail. 2020 Mar;8(3):199-208. doi: 10.1016/j.jchf.2019.10.012. Epub 2020 Feb 5.
The purpose of this study was to investigate real world safety and efficacy of hypertonic saline therapy in cases of refractory acute decompensated heart failure (ADHF) at a large U.S. academic medical center.
Hypertonic saline therapy has been described as a potential management strategy for refractory ADHF, but experience in the United States is limited.
A retrospective analysis was performed in all patients receiving hypertonic saline for diuretic therapy-resistant ADHF at the authors' institution since March 2013. The primary analytic approach was a comparison of the trajectory of clinical variables prior to and after administration of hypertonic saline, with secondary focus on predictors of treatment response.
A total of 58 hypertonic saline administration episodes were identified across 40 patients with diuretic-therapy refractory ADHF. Prior to hypertonic saline administration, serum sodium, chloride, and creatinine concentrations were worsening but improved after hypertonic saline administration (p < 0.001, all). Both total urine output and weight loss significantly improved with hypertonic saline (p = 0.01 and <0.001, respectively). Diuretic efficiency, defined as change in urine output per doubling of diuretic dose, also improved over this period (p < 0.01). There were no significant changes in respiratory status or overcorrection of serum sodium with the intervention.
In a cohort of patients who were refractory to ADHF, hypertonic saline administration was associated with increased diuretic efficiency, fluid and weight loss, and improvement of metabolic derangements, and no adverse respiratory or neurological signals were identified. Additional study of hypertonic saline as a diuretic adjuvant is warranted.
本研究旨在调查美国一家大型学术医学中心难治性急性失代偿性心力衰竭（ADHF）患者中高渗盐水治疗的真实世界安全性和疗效。
高渗盐水治疗已被描述为难治性 ADHF 的潜在治疗策略，但美国的经验有限。
对作者所在机构自 2013 年 3 月以来接受高渗盐水治疗利尿剂抵抗性 ADHF 的所有患者进行回顾性分析。主要分析方法是比较高渗盐水给药前后临床变量的变化轨迹，次要重点是治疗反应的预测因素。
共确定了 40 例利尿剂抵抗性 ADHF 患者 58 次高渗盐水给药事件。在给予高渗盐水之前，血清钠、氯和肌酐浓度恶化，但在给予高渗盐水后改善（均 p<0.001）。高渗盐水治疗后总尿量和体重减轻均显著改善（p=0.01 和 p<0.001）。在这段时间内，利尿剂效率（定义为尿量随利尿剂剂量增加两倍的变化）也有所提高（p<0.01）。干预后呼吸状况或血清钠过度纠正没有明显变化。
在难治性 ADHF 患者队列中，高渗盐水给药与增加利尿剂效率、液体和体重减轻以及改善代谢紊乱有关，且未发现呼吸或神经不良反应信号。有必要进一步研究高渗盐水作为利尿剂辅助治疗的作用。
