高渗盐水溶液在急性失代偿性心力衰竭中的早期应用效果。
The Effect of Early Administration of Hypertonic Saline Solution İn Acute Decompensated Heart Failure.
机构信息
Karabuk University, Faculty of Medicine, Department of Cardiology, Karabuk - Turquia.
出版信息
Arq Bras Cardiol. 2024 Jun;121(7):e20230818. doi: 10.36660/abc.20230818.
BACKGROUND
There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF).
OBJECTIVES
This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes.
METHODS
In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%.
RESULTS
The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups.
CONCLUSION
HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients.
背景
在急性失代偿性心力衰竭（ADHF）中，高渗盐水溶液（HSS）的初始治疗没有科学证据。
目的
本研究评估了在 ADHF 中使用 HSS 联合袢利尿剂（LD）作为一线利尿剂治疗的影响，重点关注肾功能、电解质水平和临床结局。
方法
在这项回顾性病例对照研究中，纳入了 2022 年 1 月 1 日至 2022 年 12 月 31 日期间的 171 名成人 ADHF 患者（女性 93 名/男性 78 名）。患者被分为两组： upfront combo HSS+LD 和标准化 LD。主要终点是肾功能恶化（WRF）。在 6 个月的随访期间评估了因 HF 住院和全因死亡率。在统计分析中采用的显著性水平为 5%。
结果
两组在基线特征上具有相似性。与标准化 LD 相比， upfront combo HSS+LD 组在第 1 天的尿量（3975[3000-5150]比 2583[2000-3250]，p=0.001）和第 2 小时的钠排泄量（116.00[82.75-126.00]比 68.50[54.00-89.75]，p=0.001）更高。与标准化 LD 相比，使用 HSS 会导致血清 Na+升高（137.00[131.75-140.00]比 140.00[136.00-142.25]，p=0.001 用于 upfront combo HSS，139.00[137.00-141.00]比 139.00[136.00-140.00]，p=0.0470 用于标准化 LD），而氯（99.00[94.00-103.25]比 99.00[96.00-103.00]，p=0.295）、肾小球滤过率（GFR）（48.50[29.75-72.50]比 50.00[35.50-63.50]，p=0.616）和肌酐（1.20[0.90-1.70]比 1.20[1.00-1.50]，p=0.218）在 upfront combo HSS 组中保持稳定与标准化 LD 组相比（Cl-：102.00[99.00-106.00]比 98.00[95.00-103.00]，p=0.001，eGFR：56.00[41.00-71.00]比 55.00[35.00-71.00]，p=0.050，肌酐：1.10[0.90-1.40]比 1.20[0.90-1.70]，p=0.009）。与标准化 LD 相比，WRF（16.1%比 35.5%，p=0.007）和住院时间（4 天[3-7]比 5 天[4-7]，p=0.004）更低在 upfront combo HSS+LD 中。两组在院内死亡率、因 HF 住院和全因死亡率方面相似。
结论
HSS 作为初始治疗，与 LD 联合使用时，可能在不损害 ADHF 患者肾功能的情况下提供安全有效的利尿作用。因此，HSS 可能会导致这些患者的住院时间缩短。
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