探討心臟衰竭患者實施限水措施是否能降低再住院率與死亡率之實證分析

An Evidence-based Analysis: Reduction of Readmission Rate and Mrtality in Ptients with Hart Filure by Fuid Rstriction?

背景：心臟衰竭儼然為當代重要的健康問題，患者常因體液容積過多導致肺部鬱積與下肢水腫而反覆入院，臨床上常認為限水措施是心臟衰竭照護重要的衛教措施之一。目的：探討限制水分攝取是否影響心臟衰竭病患其再入院率與死亡率。方法：採取實證步驟，運用PICO設定關鍵字並找出同義字及相關字詞，關鍵字主要為心衰竭、水分限制和再住院率或死亡率，在PubMed、EBSCOHOST、Cochrance Library與Embase等資料庫進行檢索，檢索2010年1月至2021年1月間，發表語言為中、英文，研究類型設定為SR或RCT的文章。搜尋文獻後以2013年版CASP評析工具進行評析。結果：文章搜尋結果總共四篇，研究結果一致傾向，不管心臟射出功能如何，亦不論急性失代償或慢性心臟衰竭患者，嚴格的水分限制相對於自由的水分攝取的措施，對於其再入院率與死亡率沒有顯著差異。結論：嚴格的限水措施雖然稍有助於降低失代償性心衰竭患者的鬱積現象，但是對其再住院率與死亡率並無明顯的影響。然而分析文獻中所納入臨床試驗皆為小樣本的研究，結果未必適用於所有的心衰竭病人。仍期待未來能有更大型的臨床試驗研究以證實限水措施於心衰竭處置中的角色。

Background: Heart failure has become a significant health problem in current era. Patients were hospitalized repeatedly because of pulmonary congestion and lower limbs edema caused by fluid overload. Clinically fluid restriction has been proposed as an important intervention for educating patients with heart failure. Objective: The purpose of this article is to investigate whether fluid restriction affects the readmission rate and mortality rate in patients with heart failure. Methods: Essential approach of evidence-base medicine were applied. Synonymous and relative words were searched in the structure of PICO. The key words including heart failure, fluid restriction, readmission or mortality were searched in Pubmed, EBSCOHOST, Cochrance library and Embase databank between January 2010 and January 2021. The published language was limited within Chinese and English. The type of study was within SR or RCT. The articles were appraised by a tool of CASP version 2013. Results: Four articles were found and appraised. The results consistently trended toward that regardless of level of ejection fraction and acute decompensated or chronic status of heart failure, fluid restriction dose not significantly influence readmission and mortality rate compared with liberal water intake. Conclusion: Strict water restriction might ameliorate pulmonary congestion in decompensated heart failure but does not significantly influence readmission and mortality. However, the sample size is relatively small in the analyzed articles and the result may not be appropriately applied in all situations. Clinical trials with larger sample size were expected to substaniate the role of fluid restriction in management of heart failure.