血钾不高尿毒症患者血液透析过程中补钾方式的

短篇论著

血钾不高尿毒症患者血液透析过程中补钾方式的探讨

孙 移，别 昕，龙昌顺，梁青俊

（广东医学院附属廉江医院 暨 廉江市人民医院 肾内科，广东 廉江 524400）

摘要:目的 探讨血钾不高尿毒症患者血液透析过程中最佳补钾方式。方法 2011.02-2012.02间纳入我院血透中心住院患

者50例，均使用含钾浓度为2.0 mmol/L的透析液透析，选择自身交叉对照试验方法，即同一病人均分别先后按顺序进入:对照组、动脉血路管补钾组[钾20 mmol/h (氯化钾1.5g/h)]和静脉血路管补钾组[钾6.7mmol/h (氯化钾0.5g/h)]。分别记录透析前、透析结束时及透析后2-3h血清钾；分别记录透析前、透析后和透析后2-3h心律失常情况和疲乏、恶心、呕吐、厌食、腹胀、反应迟钝、四肢无力等症状，通过对比组间患者低钾发生率及并发症情况，来探讨最佳补钾方式。结果 （1）对照组透析结束时和结束后2-3h低钾血症发生率明显高于动、静脉血路管补钾组（P<0.05）；（2）动、静脉血路管补钾组结束时及结束后2-3h均无发生高钾血症；（3）动、静脉血路管补钾组结束时及结束后2-3h低血钾发生率较对照组低（P<0.05），组间无差异（P>0.05），但补钾量前者仅为后者1/3；（4）动、静脉血路管补钾组并发症发生率较对照组低（P<0.05），

结论 对于血钾不高尿毒症患者，组间无差异（P>0.05）。在透析过程中采用静脉血路管补钾[钾6.7mmol/h (氯化钾0.5g/h)]

和动脉血路管补钾组[(钾20 mmol/h (氯化钾1.5g/h)]都可安全预防低钾血症及其并发症，其中采用静脉血路管补钾方式可以更节省氯化钾量。

关键词:血液透析；低钾血症；补钾方式 中图分类号:R 473.73

文献标识码:B

The discussion of the way of the potassium supplement in the patients

of maintenance hemodialysis

SUN Yi,BIE Xin,LONG Chang-shun,et al

(The People's Hospital of Lianjiang,Lianjiang,Guangdong 524400,P.R.China)

Abstract:【Objective】To explore the best way of the potassium supplement in the patients of maintenance hemodialysis.【Methods】Fromthe hemodialysis center of our hospital ,We calculated 50 patientsfrom February 2011 to February 2012,the cross-over controlled test method was used.Everyone was respectively in order to enter the control group, arterial potassium supplement group [20 mmol / h potassium ( potassium chloride 1.5g ) ]and intravenous potassium group [6.7mmol / h potassium ( potassium chloride 0.5g ) ]. Serum potassium concentration 、CO2CP were recorded before, at the end of and 2-3 hours after the dialysis; Arrhythmia, fatigue, weakness, fatigue, nausea, vomiting, anorexia, abdominal distension, unresponsive, lethargy, coma were recorded at the end of and 2-3 hours after the dialysis. By comparing the rate of low potassium and complications, we explore the best way of potassium supplement. 【Resluts】1)The rate of hypokalemia was highest in control group at the end of dialysis and 2-3 hours after dialysis P<0.05);2)Serum potassium concentration was normal at the end of and 2-3 hours after dialysis in intravenous potassium group and arterial potassium group;3)Compared with control group ,The incidence of hypokalemia was lower at the end of and 2-3 hours after dialysis in intravenous potassium group and arterial potassium group (P<0.05), but no differences between the groups and the quantity of potassium of the former was only 1/3 of the latter;4)There was no difference of the rate of complications in intravenous potassium and arterial potassium groups (P>0.05), but they were both lower than that of the control group (P<0.05).【Conclusion】For the patients with normal concentration of potassium before hemodialysis, the intravenousand the arterial way were all the best of way to prevent the hypokalemia and complications, but less dosage inintravenous way. Key words: hemodialysis;heparin;dosage

血液透析作为一种常见的肾脏替代治疗方法，已形成专业化得到长足发展。随着透析患者生命的延长,纳差、呕吐、腹泻、糖尿病肾病和其他相关并发症的血液透析（hemodialysis HD）患者数量的增加，低钾血症的发生率也逐渐上升[1]，而低钾血症会导致一些并发症,轻者出现腹胀、肌肉无力等,重者可引起致死性心律失常,甚至危及生命[2]，为了保持正常的钾代谢，一般需要使用较高钾浓度的透析液。

但据笔者调查所知在大多数血透中心，常规透析处方是使用钾浓度为2.0 mmol/L的透析液，仅少量备用更高钾浓度规格的透析液，原因可能与临床使用量较少、研究成本、审批成本较高等原因有关。因此，可能会出现在需要使用较高钾浓度的透析液、而又未能获得时，需考虑在透析过程中补充钾。血液透析中出现低钾血症者应积极补钾治疗, 但需要慎之又慎[3]。本研究的目的就在于探讨最佳补钾方式和安全用量，为临床血液净化工作者如何在总体钾不高的患者在透

收稿日期:2012-07-10

析过程中预防低钾血症提供实验依据。

1 资料与方法1.1一般资料

2011.02-2012.02间纳入我院血透中心住院患者50例，男性31例,女性19例,年龄(51.5±14.6)岁,体重(53.4±7.8)kg,病程(5.1±2.1)年，其中基础疾病为慢性肾小球肾炎21例，糖尿病肾病15例，高血压8例，药物性急性肾功能衰竭 2例，复杂性肾结石并梗阻性肾病3例，多囊肾l例。1.2入组标准

血透标准参照美国肾脏病基金（NKF）会颁布的《肾脏病/透析临床实践指南（K/DOQI）》，所有患者入组前均排除呼吸性酸中毒、呼吸性碱中毒，或者纠正失代偿性代谢性酸中毒、代谢性碱中毒后（动脉血pH值在7.35-7.45间或静脉血CO2CP在22-31 mmol/L），且血清钾在正常值范围内。1.3试验分组及方法