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Aggressive Fluid and Sodium Restriction in Acute Decompensated Heart Failure: A Randomized Clinical Trial 急性失代偿期心衰病人严格水钠限制的效果：随机临床研究 JAMA Intern Med. 2013;173(12):1058-1064. doi:10.1001/jamainternmed.2013.552. doi:10:1001/jama.2010.920 Importance The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear. 背景：对于因为急性失代偿期心衰（ADHF）住院的病人，严格限制水钠摄入的获益仍未明确。 Objective To compare the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodium-restricted (maximum dietary intake, 800 mg/d) diet (intervention group [IG]) vs a diet with no such restrictions (control group [CG]) on weight loss and clinical stability during a 3-day period in patients hospitalized with ADHF. 目的：在一个因ADHF住院的病人群体中，我们对比了严格水钠摄入（液体摄入不高于800mL/d；钠摄入不高于800mg/d；干预组IG）与不限制水钠摄入（对照组CG）在三天内的体重和临床症状变化。 Design Randomized, parallel-group clinical trial with blinded outcome assessments. 设计：随机平衡组临床研究，转归评估为盲性。 Setting Emergency room, wards, and intensive care unit. 设置：急救中心，病房和ICU。 Participants Adult inpatients with ADHF, systolic dysfunction, and a length of stay of 36 hours or less. 病人：ADHF成年住院病人，收缩功能障碍，入院36小时内。 Intervention Fluid restriction (maximum fluid intake, 800 mL/d) and additional sodium restriction (maximum dietary intake, 800 mg/d) were carried out until the seventh hospital day or, in patients whose length of stay was less than 7 days, until discharge. The CG received a standard hospital diet, with liberal fluid and sodium intake. 干预：IG组在住院期间施行至少七天的严格水钠摄入限制（液体摄入不高于800mL/d；钠摄入不高于800mg/d）。若住院少于七天，则全程限制。CG组则接受常规的饮食，包括液体和钠的摄入。 Main Outcomes and Measures Weight loss and clinical stability at 3-day assessment, daily perception of thirst, and readmissions within 30 days. 主要转归和测量：评估3天内的体重下降和临床稳定，30天内的饥渴感和重新入院。 Results Seventy-five patients were enrolled (IG, 38; CG, 37). Most were male; ischemic heart disease was the predominant cause of heart failure (17 patients [23%]), and the mean (SD) left ventricular ejection fraction was 26% (8.7%). The groups were homogeneous in terms of baseline characteristics. Weight loss was similar in both groups (between-group difference in variation of 0.25 kg [95% CI, ?1.95 to 2.45]; P = .82) as well as change in clinical congestion score (between-group difference in variation of 0.59 points [95% CI, ?2.21 to 1.03]; P = .47) at 3 days. Thirst was significantly worse in the IG (5.1 [2.9]) than the CG (3.44 [2.0]) at the end of the study period (between-group difference, 1.66 points; time × group interaction; P = .01). There were no significant between-group differences in the readmission rate at 30 days (IG, 11 patients [29%]; CG, 7 patients [19%]; P = .41). 结果：共纳入75名病人，大部分为男性。大部分病人的心衰原因为缺血性 心脏病，平均SD左心室射血分数为26％。病人的基线特征相差不大。在三天后的评估中，两个组别的体重减轻和临床评分等相似。与CG相比，IG组病人在研究结束时的饥渴感明显更严重。而对于30天内的重新入院率，两个组别之间的差别不大。 Conclusions and Relevance Aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at 3 days and is associated with a significant increase in perceived thirst. We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary. 结论：严格限制ADHF病人的水钠摄入，对住院三天内的体重减轻和临床症状等无明显影响，且显著增加了病人的渴感。因此，严格限制ADHF病人的水钠摄入是没有必要的。 请关注医学专业新闻的微信，在微信“添加朋友”里搜索medicalnews即可 |
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