危重患者高浓度静脉补钾的安全性和疗效研究  

Study on safety and efficacy of concentrated potassium chloride infusions in critically ill patients with hypokalemia

作　　者：何清[1] 王菁华[1] 刘亚林[1] 唐普贤[1] 常志刚[1] 杜立清 黄秀峰 

机构地区：[1]卫生部北京医院ICU,北京100730 [2]河北省丰润县人民医院ICU,河北唐山064000 [3]山西省原平市铁路医院,山西原平034100

出　　处：《中国危重病急救医学》2008年第7期416-418,共3页Chinese Critical Care Medicine

摘　　要：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）〉0．5ml／s且每小时尿量〉50m13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1208mmol／L（相当于质量分数为9％的KCI溶液）、201mmol／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〉0．053；治疗组补钾的液体量明显低于对照组[（124．36±25．79）ml比（680．83±236．70）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。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.

关 键 词：危重病 高浓度钾 微量泵 低钾血症 

分 类 号：R459.7[医药卫生—急诊医学]