严重低钾血症致麻醉后潜在致命性心律失常1例的术中管理  

Intraoperative management of potentially fatal arrhythmias after anesthesia induced by severe hypokalemia:A case report

作　　者：王洁初 姚优修[1] 郭向阳[1] WANG Jie-chu;YAO You-xiu;GUO Xiang-yang(Department of Anaesthesiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院麻醉科,北京100191

出　　处：《北京大学学报（医学版）》2023年第1期186-189,共4页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(81500178)。

摘　　要：严重低钾血症的定义为血清钾离子浓度低于2.5 mmol/L,如不及时有效救治可引起严重的心律失常和呼吸肌麻痹而危及患者生命^([1])。低钾血症常由于患者长期进食不足,应用排钾利尿剂,呕吐、持续胃肠减压,钾离子向组织内转移等原因导致。清醒患者出现低钾血症最早的临床表现是肌无力,一旦出现呼吸肌受累,可致呼吸困难或窒息。全身麻醉的患者可仅表现为心律失常,典型的心电图表现为T波低平或倒置,随后出现ST段降低、QT间期延长和U波^([2])。Severe hypokalemia is defined as the concentration of serum potassium lower than 2.5 mmol/L,which may lead to serious arrhythmias and cause mortality.We report an unusual case of potentially fatal ventricular arrhythmias induced by severe hypokalemia in a patient undergoing laparoscopic partial nephrectomy in Peking University Third Hospital due to irregular use of indapamide before operation.Indapamide is a sulfonamide diuretic with vasodilative and calcium antagonistic effects,which enhances sodium delivery to the renal distal tubules resulting in a dose-related increase in urinary potassium excretion and decreases serum potassium concentrations.The electrolyte disorder caused by the diuretic is more likely to occur in the elderly patients,especially those with malnutrition or long-term fasting.Hence,the serum potassium concentration of the patients under indapamide therapy,especially elderly patients,should be monitored carefully.Meanwhile,the potassium concentration measured by arterial blood gas analysis is different from that measured by venous blood or laboratory test.According to the previous research,the concentration of potassium in venous blood was slightly higher than that in arterial blood,and the difference value was 0.1-0.5 mmol/L.This error should be taken into account when rapid intravenous potassium supplementation or reduction of blood potassium level was carried out clinically.In the correction of severe hypokalemia,the standard approach often did not work well for treating severe hypokalemia.The tailored rapid potassium supplementation strategy shortened the time of hypokalemia and was a safe and better treatment option to remedy life-threatening arrhythmias caused by severe hypokalemia with a high success rate.Through the anesthesia management of this case,we conclude that for the elderly patients who take indapamide or other potassium excretion diuretics,the electrolyte concentration and the general volume state of the patients should be comprehensively measured and fully evaluated before o

关 键 词：低钾血症 吲达帕胺 心律失常 麻醉 

分 类 号：R614[医药卫生—麻醉学]