CAJ | 학술논문

目的探讨高浓度钾微量泵入治疗危重患者低钾血症的安全性及有效性.方法 128例合并低钾血症的危重患者[内生肌酐清除率(CCr)＞0.5 ml/s且每小时尿量＞50 ml]被随机分为治疗组和对照组,各64例.治疗组和对照组补钾浓度分别为1 208 mmol/L(相当于质量分数为9%的KCl溶液)、201 mmol/L(相当于1.5%的KCI溶液),补钾速度相同.均进行严密监测与血钾浓度监测,血钾正常时停止补钾.结果治疗组和对照组补钾时间比较差异无统计学意义[(15.55±3.22)h比(14.18±4.93)h,P＞0.05];治疗组补钾的液体量明显低于对照组[(124.36±25.79)ml比(680.83±36.70)ml,P＜0.01].两组治疗过程中均未发生明显血流动力学变化、高钾血症或急性心功能不全.两组患者肾功能是否正常对补钾时间无明显影响.补钾前血钾浓度与补钾量有一定相关性(相关系数r=-0.259,P＜0.01).结论高浓度钾微量泵入治疗危重患者低钾血症可以在短时间内纠正低钾血症,是安全有效的.肾功能轻度异常但无少尿及无尿的患者也可以在严密监测下高浓度补钾.
목적 탐토고농도갑미량빙입치료위중환자저갑혈증적안전성급유효성.방법 128례합병저갑혈증적위중환자[내생기항청제솔(CCr)＞0.5 ml/s차매소시뇨량＞50 ml]피수궤분위치료조화대조조,각64례.치료조화대조조보갑농도분별위1 208 mmol/L(상당우질량분수위9%적KCl용액)、201 mmol/L(상당우1.5%적KCI용액),보갑속도상동.균진행엄밀감측여혈갑농도감측,혈갑정상시정지보갑.결과 치료조화대조조보갑시간비교차이무통계학의의[(15.55±3.22)h비(14.18±4.93)h,P＞0.05];치료조보갑적액체량명현저우대조조[(124.36±25.79)ml비(680.83±36.70)ml,P＜0.01].량조치료과정중균미발생명현혈류동역학변화、고갑혈증혹급성심공능불전.량조환자신공능시부정상대보갑시간무명현영향.보갑전혈갑농도여보갑량유일정상관성(상관계수r=-0.259,P＜0.01).결론 고농도갑미량빙입치료위중환자저갑혈증가이재단시간내규정저갑혈증,시안전유효적.신공능경도이상단무소뇨급무뇨적환자야가이재엄밀감측하고농도보갑.
Objective To explore the safety and clinical efficacy of intravenous infusion of concentrated potassium chloride using micropumps in critically ill patients with hypokalemia. Methods One hundred and twenty-eight critically ill patients with hypokalemia, the endogenous creatinine clearance rate over 0.5 ml/second and the urine output over 50 ml/hour were randomly divided into the therapy group (n=64)and the control group (n= 64). Patients in therapy group received 1 208 mmol/L (9%) KCI, while those in the control group received 201 mmol/L (1.5%) potassium chloride, intravenously with the aid of a micropump, with hourly equal quantity of KCI in both groups. Patients in both groups were monitored strictly, and the potassium infusion was stopped whenever the serum potassium exceeded or equal to 3.5 mmol/L. Results It took (15.55±3.22) hours and (14.18±4.93) hours for the therapy group and the control group to correct the hypokalemia respectively, and there was no significant difference (P＞0.05).Potassium infusion brought larger amount of fluid in the control group than the therapy group [(124.36+25.79) ml vs. (680. 83+236.70) ml, P＜0.01]. All patients tolerated the infusion without evidence of hemodynamic change, hyperkalemia or acute heart dysfunction. For all the patients, renal function did not throw significant influence on the potassium infusion time. An inverse correlation was observed between preinfusion potassium concentration and the quantity of potassium infused (r =- 0.259, P＜0.01).Conclusion Under meticulous monitoring, it is safe and effective to infuse concentrated potassium for the critically ill patients with hypokalemia. This strategy can also be followed in patients with mild renal dysfunction but without oliguria or anuria under careful monitoring.