不同透析液钾离子浓度对透析前血钾及透析中心律失常的影响  

Effects of different dialysate potassium concentration on serum potassium and cardiac arrhythmia during hemodialysis

作　　者：刘日光[1] 陈林[1] 傅君舟[1] 陈浩雄[1] 周姗姗[1] 陈磊[1] 

机构地区：[1]广州医科大学附属广州市第一人民医院肾内科,广州510180

出　　处：《中国血液净化》2014年第4期298-301,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨2种透析液钾离子浓度(dialysate potassium,KD)对透析前血钾、高钾血症和透析中严重心律失常事件发生率的影响。方法 1个单中心、开放、自身对照试验,以一定标准纳入患者。于2010年5月某周在用KD=2.0mmol/L(简称KD2.0,以下类同)时为所有入组患者查透析前血钾(此时间点定义为0点),之后调整至KD2.5,分别于2周、4周、8周和12周查透析前血钾。收集0点前后12周内透析中严重心律失常事件。对比调整KD前后的血钾水平、高钾血症和严重心律失常事件发生率。结果入组158例患者,2例退出,156例纳入分析。对比KD2.0,使用KD2.5虽然使透析中严重心律失常发生率有所下降,但差异无统计学意义(0.78%比0.47%,P=0.054)。在上调KD2周后,患者透析前平均血钾、高钾血症及严重高钾血症发生率均显著高于0点,分别为4.78±0.80比4.51±0.79 mmol/L、26.9%比15.4%、9.6%比3.2%,P均<0.05。加予临床干预10周后,透析前平均血钾仍高于0点,但高钾血症发生率可下降至0点水平。结论使用KD2.5比KD2.0可使透析中严重心律失常发生率有下降趋势,但可导致透析前高钾血症增多,后者可通过临床干预予以控制。Objective To investigate the effects of dialysate potassium concentration （KD） on predialyt- ic serum potassium, hyperkalemia and intradialytic cardiac arrhythmia. Methods A single-centered, open and self-controlled trial was conducted, and the patients fit the assigned criteria were enrolled in this trial. Their predialytic serum potassium was examined within a week in May, 2010 when KD = 2.0 mmol/L （KD 2.0） was used, and this time period was treated as the zero point. KD was then changed to 2.5 mmol/L （KD 2.5）. Pre- dialytic serum potassium was re-examined after the use of KD 2.5 for 2, 4, 8, and 12 weeks. Serious arrhyth- mia events in the 12 weeks before the zero point and after the zero point were recorded. Serum potassium and the incidence of hyperkalemia and severe arrhythmia events were compared before and after the use of KD 2.5. Results A total of 158 patients were enrolled including 2 patients exited during the study, and 156 patients could be analyzed. The incidence of serious intradialytic arrhythmia lowered when KD 2.5 was used but with- out statistical significance as compared with that when KD 2.0 was used （0.47% vs. 0.78%; P=-0.054）. After di- alysis with KD 2.5 for 2 weeks, Predialytic serum potassium level, the incidence of hyperkalemia and severe hyperkalemia were significantly higher than those before the zero point （4.51±0.79 vs. 4.78±0.80 mmol/L, 15.4% vs. 26.9%, and 3.2% vs. 9.6%, respectively; P〈0.05）. After clinical intervention for 10 weeks, the inci- dence of hyperkalemia decreased to the level befroe the zero point, but predialytic mean serum potassium was still higher than the level before the zero point. Conclusions The incidence of intradialytic serious arrhyth- mia was lower in patients using KD 2.5 than in those using KD 2.0. However, KD 2.5 led to the increase of predi- alytic hyperkalemia that could be controlled by clinical intervention.

关 键 词：肾透析 透析液 钾离子浓度 心律失常 心源性 

分 类 号：R318.16[医药卫生—生物医学工程]