研究背景：充血是導致急性失代償性心臟衰竭病人住院的主因，針劑利尿劑為首選去充血治療策略，但病人在治療過程常伴隨口渴不適感受，使其陷入生理症狀困擾與醫囑限制的兩難。口渴作為體液調節的重要機制之一，傳統上多被視為脫水的指標，然有關急性期病人充血狀態與口渴的動態變化及其相關性仍不明確。
研究目的：探討急性失代償性心臟衰竭病人住院期間充血狀態與口渴變化及相關性。
研究方法：本研究採前瞻性、相關性研究設計，透過方便取樣法於南部某醫學中心之心臟科病房、心臟加護病房進行收案。納入條件為年齡18歲以上、意識清楚且可正常對談、入院診斷為急性失代償性心臟衰竭或符合佛萊明漢充血性心臟衰竭診斷標準(Framingham Criteria for Congestive Heart Failure)：兩項主要標準或一項主要標準加上兩項次要標準、使用針劑利尿劑；排除條件為入院即診斷為低血容積性休克、嚴重糖尿病、有尿崩症病史、行血液透析或腹膜透析。每位病人將於入院日（T0）、停用針劑利尿劑改為口服劑型（T1）及出院日（T2）進行資料收集。研究工具包含自擬之人口學及疾病特性量表、Lucas充血分數量表及臺灣版心臟衰竭口渴困擾量表。資料分析使用RStudio，描述性資料以平均數、標準差、中位數、四分位距、百分比及頻率呈現；推論性統計則包含獨立t檢定、單因子變異數分析、皮爾森相關性分析及線性混合模型。
研究結果：本研究共納入122位病人，平均年齡68歲，63.1%為男性，左心室射出分率為42.8 %，平均住院天數為10.3天，入院時多數為NYHA Class IV (71.3%)，主要共病為高血壓(61.5%)、糖尿病(55.7%)及心律不整(53.3%)。在變化趨勢方面，充血(F = 879.26, p < .001)及口渴(F = 22.06, p < .001)兩者皆隨時間顯著改善。在相關性分析中，NYHA功能分級為唯一於三個時間點皆與口渴呈顯著相關的變項；檢驗指標中僅T1之血清鈉(r = .31, p = .002)與單日最大利尿劑劑量(r = .25, p = .009)與口渴呈正相關。線性混合模型顯示，未調整模型中時間與充血皆與口渴顯著相關，但在控制NYHA後兩者即不再達顯著，僅NYHA保留獨立解釋力(estimates = 2.85, SE = 0.79, p < .001)。
研究結論：本研究結果顯示，主觀的口渴感受隨著心臟衰竭嚴重度增加。口渴與充血狀態雖皆隨治療而改善，然兩者變化幅度並不一致，且口渴於個體間呈現高度異質性，反映病人在症狀調節與治療反應上的多樣態。建議未來可將口渴納入例行性照護評估，以輔助治療策略之調整，並更貼近病人的個別照護需求。

This prospective correlational study aimed to investigate the trends and relationship between congestion status and thirst in hospitalized patients with acute decompensated heart failure (ADHF). The inclusion criteria were as follows: patients aged 18 or above, clear and conscious, and able to communicate, diagnosed with ADHF or meeting the Framingham Criteria for Congestive Heart Failure (meeting two major criteria or one major criterion plus two minor criteria), and using intravenous diuretics. Patients diagnosed with hypovolemic shock, severe diabetes, a history of diabetes insipidus, or those undergoing dialysis were excluded. A total of 122 participants were recruited using convenience sampling from the cardiology ward and cardiac care unit of a medical center in southern Taiwan between September 2023 and August 2024. Data were collected on admission, during the transition from intravenous to oral diuretics, and at discharge. The analysis methods included descriptive statistics, independent t-tests, Welch’s ANOVA, Pearson correlation, and mixed-effects models. The results showed that both congestion and thirst improved significantly over time. NYHA was the only variable consistently correlated with thirst across all three time points. However, after adjustment for NYHA functional class, time, and congestion, neither time nor congestion remained a significant predictor of thirst. Thirst increased in proportion to heart failure severity and showed substantial interindividual variability, suggesting its potential value in routine clinical assessment.

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