糖尿病患者体外循环心脏术后早期补钾经验及治疗措施  

Experience and treatment of early potassium supplementation in diabetes patients undergoing cardiopulmonary bypass

作　　者：霍明[1] 张冬杰[1] 姜楠[1] 林琳[1] 王维铁 HUO Ming;ZHANG Dongjie;JIANG Nan;LIN Lin;WANG Weitie(Department of Cardiovascular Surgery,The Second Hospital of Jilin University,Changchun,130000, China;Department of Cardiovascular Surgery,the First Center Hospital in Tianjing City)

机构地区：[1]吉林大学第二医院心外科,长春130000 [2]天津市第一中心医院心外科

出　　处：《临床心血管病杂志》2018年第12期1223-1226,共4页Journal of Clinical Cardiology

摘　　要：目的:讨论糖尿病患者体外循环心脏术后早期补钾经验及出现高钾血症的治疗对策。方法:选取2015-01-2017-07期间100例糖尿病行心脏术后患者,随机分为低钾目标组和高钾目标组,同时选取非糖尿病心脏术后患者50例作为对照组。低钾目标组术后按钾离子目标值4.0mmol/L进行补钾,高钾目标组和对照组按照常规钾离子目标值4.5mmol/L进行补钾。比较3组术后相关指标的差异。结果:3组患者住院期间无死亡。相比高钾目标组,低钾目标组和对照组术后高钾血症、高血糖、心室颤动、心脏骤停、透析、高糖胰岛素应用发生率明显减少(均P<0.05),低钾血症、心房颤动发生率增高(均P<0.05)。3组术后心功能不全、围术期心肌梗死、肺水肿、肺部感染、肾功能不全、伤口愈合不良、神经系统并发症、住院时间等指标比较差异无统计学意义(P>0.05)。结论:糖尿病患者术后胰岛素泵控制血糖期间可适度降低补钾目标值,防止血糖稳定后停用胰岛素后高钾血症的发生,值得临床借鉴。Objective:To discuss the experience and treatment of early potassium supplementation in diabetes patients undergoing cardiopulmonary bypass.Method:From January 2015 to July 2017,100 diabetes patients undergoing cardiac surgery were randomly divided into two groups.Fifty non diabetic patients with heart surgery were selected as control group.Target potassium supplementation as 4.0 mmol/L was observed in low target potassium group,and target potassium supplementation as 4.5 mmol/L was observed in high target potassium and control group according to conventional potassium target.The differences of postoperative relative indexes among the 3 groups were compared.Result:There was no death in the 3 groups during hospitalization.Compared with the high target potassium,low target potassium and control group postoperative hyperkalemia,hyperglycemia,ventricular fibrillation,cardiac arrest,dialysis,high glucose insulin application cases decreased significantly (P<0.05),while hypokalemia and atrial fibrillation increased (P<0.05).Conclusion:The target value of potassium supplementation can be reduced moderately during using insulin pump control blood sugar in diabetic patients after heart operation.

关 键 词：高钾血症 低钾血症 心室颤动 心房颤动 糖尿病 冠状动脉旁路移植术 

分 类 号：R541.7[医药卫生—心血管疾病]