以實證探討心衰竭病患之水分限制

Evidence-Based Practice of Fluid Restriction in Patients with Heart Failure

心衰竭是伴隨人口老化所衍生出高盛行率的健康問題之一，藥物與非藥物治療可顯著改善心衰竭病患之存活與生活品質，而維持心衰竭病患足夠的體液，可確保血流動力學平衡及適當的組織灌注，此可減少因心輸出量降低所引發之神經荷爾蒙活化反應。但體液負荷衍生的呼吸喘、水腫等不適症狀，仍經常困擾病患，因此，除常規藥物治療外，水分限制常被建議為心衰竭病患的照護處置之一。本文之目的在回顧過去以「水分控制」為介入處置之研究，由PubMed及CINAHL查得四篇隨機控制試驗之報告，這些研究結果建議，水分限制對病情穩定且有適當藥物治療之心衰竭個案，可能未必利多於弊，另外，心衰竭病患之水分控制在臨床實務應用上，亦需考量病患個別體重、鈉攝取量以及水分控制遵從性等。然而，這些研究並未選擇腎臟功能不全個案為對象，也未長期追蹤水分控制處置介入後的效果。總之，未來仍需更多臨床實驗佐證，以提供臨床照護實證之適用性。

Heart failure (HF) is prevalent in the aging population. Both pharmacological and non-pharmacological therapies are employed in HF and have yielded significant improvements in survival and quality of life. Body fluid must be maintained at a level sufficient to ensure hemodynamic stability and adequate tissue perfusion, which may decrease neurohormonal activation caused by low cardiac output in patients with HF. However, shortness of breath and peripheral edema caused by fluid overload remain the most common clinical symptoms of HF, causing patient distress. In addition to routine pharmacologic approaches, fluid restriction is frequently suggested in HF management strategies. The purpose of this review of published studies that examined use of fluid/water restriction as an intervention was to determine the optimal fluid intake for HF patients in clinical practice. Four articles describing three clinical trials were identified via PubMed and CINAHL. Their findings suggest that patients with clinically stable HF receiving optimal pharmacological treatment may not benefit from fluid restriction. Patients in these studies had preserved renal function, however, and the trials had no long-term follow-up period. Clinicians choosing to restrict fluid intake for patients with HF should consider an individualized fluid prescription, potentially based on patient body weight, sodium intake, and likelihood of adherence. Further clinical trials are warranted to improve clinical practice in caring for patients with HF.