Hsu Suh-Meei, Lin Yueh-Hung, Lin Ying-Chun, Liu Shu-Jung, Liu Chih-Ju, Hung Chung-Lieh, Wang Tsae-Jyy
Nursing and Management, MacKay Junior College of Medicine, Taipei, Taiwan; Department of Nursing, MacKay Memorial Hospital, Taipei, 10449, Taiwan; Institute of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Department of Medicine, MacKay Medical College, New Taipei City, 25245, Taiwan; Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, 10449, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Formos Med Assoc. 2025 Jul;124(7):650-659. doi: 10.1016/j.jfma.2024.11.017. Epub 2024 Nov 27.
Heart failure (HF) management lacks clarity regarding fluid balance strategies, with some studies suggesting potential benefits of liberal fluid intake. This review aims to evaluate both unrestricted and restricted fluid intake, including sodium restriction, in adult HF.
A thorough search of electronic databases, including PubMed, MEDLINE, and Cochrane Library, identified relevant studies examining fluid intake effects on adult heart failure patients, categorized by liberal or restricted intake, with subgroup analysis on sodium restriction. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated, employing trial sequential analysis (TSA) for reliability. Nine studies involving 961 patients were included, with follow-up durations ranging from 2 days to 6 months.
Daily fluid intake ranged from 0.8 to 1.5 L for the intervention group, and sodium intake varied from 2.0 to 5.0 g per day across five studies. No significant differences were observed in re-hospitalization rate, mortality rate, thirst, quality of life, doses of diuretics, or serum sodium levels between liberal and restricted intake groups. However, fluid-restricted patients exhibited increased serum creatinine levels, decreased serum B-type natriuretic peptide (BNP) levels and reduced body weight.
In summary, the existing studies on this topic are hindered by heterogeneity and relatively small sample sizes. However, when the available data is combined, it suggests that HF patients managed with either liberal or restrictive fluid intake exhibit similar clinical outcomes. It's worth noting that fluid restriction in HF patients might lead to increased serum creatinine levels, decreased BNP and body weight.
心力衰竭（HF）管理在液体平衡策略方面缺乏明确性，一些研究表明自由液体摄入可能有益。本综述旨在评估成人HF中不受限制和受限的液体摄入，包括钠限制。
对电子数据库进行全面检索，包括PubMed、MEDLINE和Cochrane图书馆，确定了相关研究，这些研究考察了液体摄入对成人心力衰竭患者的影响，按自由或受限摄入进行分类，并对钠限制进行亚组分析。计算合并比值比（OR）和加权平均差（WMD），采用试验序贯分析（TSA）以确保可靠性。纳入了9项涉及961名患者的研究，随访时间从2天到6个月不等。
干预组的每日液体摄入量为0.8至1.5升，五项研究中的钠摄入量为每天2.0至5.0克。自由摄入组和受限摄入组在再住院率、死亡率、口渴、生活质量、利尿剂剂量或血清钠水平方面未观察到显著差异。然而，液体受限的患者血清肌酐水平升高，血清B型利钠肽（BNP）水平降低，体重减轻。
总之，关于该主题的现有研究受到异质性和相对较小样本量的阻碍。然而，综合现有数据表明，采用自由或受限液体摄入管理的HF患者具有相似的临床结果。值得注意的是，HF患者的液体限制可能导致血清肌酐水平升高、BNP降低和体重减轻。
