The Prevention Of Hypokalemia During The Standardized Treatment And Loop Diuretic For Chronic Heart Failure Patients

Objectives:To explore the prevention of hypokalemia for chronic heart failure patients to accept ACEI/ARB,? receptor blocker,aldosterone antagonist and loop diuretic therapy.Method:Choose 90 chronic heart failure outpatients with New York Heart Association class ? or ? and fluid retention,which must be treated with loop diuretics,visiting the first hospital of Lanzhou university between September 2015 and September 2016.Adopting digital form were randomly divided into A,B two groups,41 cases of group A and group B in 49 cases.Two groups of patients were given standardized treatment and loop diuretic,oral potassium citrate to supplement potassium in group A,group B do not give potassium,and monitor the change of blood potassium,blood sodium,blood uric acid,serum creatinine,glomerular filtration rate and blood urea nitrogen etc.Results:Two groups do not appear hypokalemia,and their potassium levels after treatment have no statistical difference(P = 0.07);The cardiac function of two groups after treatment improve obviously than before,difference have statistical significance(P = 0.00,P = 0.00);Two groups do not appear hyponatremia,and their sodium levels after treatment have no statistical difference(P = 0.88);In the two groups of serum potassium,serum sodium,blood uric acid,serum creatinine,blood urea nitrogen,glomerular filtration rate after treatment than before have no statistical significance before(P > 0.05).Conclusion:For chronic heart failure outpatients,under the condition of normal diet(no restrict strictly sodium salt diet)and normal renal function,with standardized treatment and loop diuretic,will not cause hypokalemia and hyponatremia;NYHA cardiac function improve to various extent.Objectives:To systematically assess the clinical usefulness of nitrates for patients with chronic heartfailure.Method:We searched Pub Med,EMbase,Web of Science,The Cochrane Library(Issue 1,2016),CBM,CNKI,VIP,and Wan Fang Data to collect randomized controlled trials(RCTs)and cross-over studies about nitrates in the treatment of heart failure from inception to January 4th 2016.Two reviewers independently screened literature,extracted data and evaluated the risk of bias of included studies.Then,meta-analysis was performed by Rev Man 5.3 software.Results:Ten trials were included involving 414 patients(195 patients in the nitrates group and 219 patients in the control group).The results of meta-analysis showed that,compared with the control group,the nitrates group could reduce arterial blood pressure(MD= –1.91,95%CI –3.66 to –0.16,=0.03),pulmonary wedge pressure vessels(PCWP)(MD= –2.00,95%CI –3.84 to –0.15,P=0.03),increase cardiac index(CI)(MD=0.25,95%CI 0.09 to 0.42,P=0.003),treadmill exercise time(MD=70.14,95%CI 55.22 to 85.05,P<0.000 01);but easily emerge side effects(OR=5.21,95%CI 2.60 to 10.41,P<0.000 01).Conclusion:Current evidence indicates that nitrates treatment could improve the hemodynamic effect,enhance cardiac output and increase exercise tolerance in patients with heart failure.