低钾血症对颅脑创伤患者预后的影响  

Severe hypokalemia is a risk factor of mortality in patients with traumatic brain injury

作　　者：吴建跃[1] 王卫民[1] 肖国民[1] 程军[1] 袁云鹏[1] 张眉[1] 丁皓俊 姜启周[1] 

机构地区：[1]杭州师范大学附属医院神经外科,310015

出　　处：《浙江医学》2015年第3期211-215,共5页Zhejiang Medical Journal

摘　　要：目的：探讨低钾血症在颅脑创伤患者中的发病情况及其与预后的关系。方法2010年6月至2013年6月共有168例住院期间出现低钾血症且年龄≥18岁的颅脑创伤患者纳入研究。依据低钾血症严重程度的不同，将患者分成轻度组（3.00 mmol/L≤血钾＜3.50mmol/L）、中度组（2.50mmol/L≤血钾＜3.00mmol/L）和重度组（血钾＜2.50mmol/L），各组均采用患者血钾的最低值进行数据分析。高钠血症和低磷血症分别被定义为血钠＞147.00mmol/L和血磷＜0.80mmol/L。结果受试患者的血钾在1.10-3.40mmol/L，平均2.90mmol/L。当血钾出现最低值时，与其余两组比较，重度组患者具有更高的血钠和更低的血磷水平（均P＜0.01）。与轻度组（10.5%）或中度组（25.7%）相比，重度组患者的病死率（82.1%）显著上升（均P＜0.01）。多变量逻辑回归分析结果显示，低格拉斯哥昏迷评分（OR=1.28，95%CI=1.12-1.42，P＜0.01）、低血钾（OR=5.57，95%CI=2.76-10.93，P＜0.01）、低血磷（OR=2.76，95%CI=1.11-7.25，P＜0.01）以及高血尿素氮（OR=1.16，95%CI=1.07-1.24，P＜0.01）是导致患者死亡的独立危险因素。结论颅脑创伤患者是出现低钾血症的高危人群，重度低钾血症的患者更容易合并高钠血症和低磷血症。重度低钾血症和低磷血症是颅脑创伤患者死亡的独立危险因素。Objective To investigate the prevalence of severe hypokalemia and outcome in traumatic brain injury （TBI） and its relation with outcome of patients. Methods One hundred and sixty eight TBI patients age≥18 yrs with hypokalemia ad-mitted between June 2010 and June 2013 were recruited in the study. Hypokalemia （〈3.50mmol/L） was classified into 3 degrees of severity：mild （3.00mmol/L≤K＋〈3.50mmol/L）, moderate （2.50mmol/L≤K＋〈3.00mmol/L） and severe（K＋〈2.50mmol/L）. The minimal level of serum potassium during hospitalization was used for analysis. Hypernatremia and hypophosphatemia were de-fined as serum sodium＆gt;147.00mmol/L and serum phosphorus 〈0.80mmol/L in the blood. Results The mean level of lowest serum potassium for the 168 patients was 2.90mmol/L（1.10mmol/L-3.40mmol/L）. TBI patients with severe hypokalemia had signif-icantly higher serum sodium and lower serum phosphorus than those patients with mild or moderate hypokalemia （P〈0.01）. The fatality rates in mild, moderate and severe hypokalemia groups were 10.5%, 25.7%and 82.1%, respectively （P〈0.01）. Multiple lo-gistic regression analysis revealed that decreased GCS （OR=1.28, 95%CI=1.12-1.42, P〈0.01）, low potassium level （OR=5.57, 95%CI=2.76-10.93, P〈0.01）, low phosphorus level （OR=2.76, 95%CI=1.11-7.25, P〈0.01）, and increased BUN （OR=1.16, 95%CI=1.07-1.24, P〈0.01） were significantly associated with increased risk of mortality. Conclusion Our study demonstrates that TBI patients are likely to have hypokalemia;and severe hypokalemia and hypophosphatemia are the independent risk factors for mortality in TBI patients.

关 键 词：重度低钾血症 颅脑创伤 高钠血症 低磷血症 

分 类 号：R651.15[医药卫生—外科学]