老年低钾血症病人补钾后继发高钾血症的危险因素分析  

Risk factors for secondary hyperkalemia after potassium supplement in elderly patients with hypokalemia

作　　者：谢媛媛 陈敬绵[1] 邓婷 高磊 XIE Yuanyuan;CHEN Jingmian;DENG Ting;GAO Lei(Department of Emergency Medicine,China Rehabilitation Research Center(Beijing Bo’ai Hospital),Beijing 100068,China)

机构地区：[1]中国康复研究中心(北京博爱医院)急诊科,北京市100068

出　　处：《实用老年医学》2024年第7期701-704,共4页Practical Geriatrics

摘　　要：目的 探索老年低钾血症病人补钾后继发高钾血症的危险因素。方法 选择2020年1—12月于中国康复研究中心(北京博爱医院)住院且合并低钾血症的648例老年病人,补钾后继发高钾血症者纳入低钾后高钾组,其余病人纳入对照组,回顾性分析2组临床资料。采用二元Logistic回归分析老年人补钾后继发高钾血症的危险因素。结果 648例老年低钾血症病人中补钾后继发高钾血症的发生率为11.6%(75/648)。低钾后高钾组的病人年龄、卒中和慢性肾功能不全的患病率、基线血钾水平、口服补钾比例及袢利尿剂、胰岛素和抗生素的使用率均高于对照组,估算的肾小球滤过率(eGFR)和Hb水平低于对照组(P<0.05)。经多因素二元Logistic回归分析,eGFR<60 mL/(min·1.73 m^(2))(OR=2.49, 95%CI:1.43~4.32)、Hb<90 g/L(OR=2.86, 95%CI:1.49~5.51)、基线血钾水平偏高(OR=1.78,95%CI:1.09~2.92)、使用胰岛素(OR=2.57,95%CI:1.47~4.50)和使用抗生素(OR=2.39, 95%CI:1.05~5.43)为老年低钾血症病人补钾后继发高钾血症的危险因素。结论 老年低钾血症病人在接受补钾治疗后继发高钾血症风险高,对于合并危险因素的病人补钾需谨慎。Objective To explore the risk factors for secondary hyperkalemia after potassium supplementation in the elderly patients with hypokalemia.Methods A total of 648 elderly patients with hypokalemia who were hospitalized in China Rehabilitation Research Center(Beijing Bo’ai Hospital)from January to December 2020 were consecutively enrolled.The patients presenting with secondary hyperkalemia after potassium supplementation were enrolled into the secondary hyperkalemia group,and the other patients were enrolled into the control group.The clinical data of two groups were collected for retrospective analysis.Binary Logistic regression analysis was used to analyze the rise factors for hyperkalemia in the elderly patients with hypokalemia.Results The incidence rate of secondary hyperkalemia after potassium supplementation in the elderly patients with hypokalemia was 11.6%(75/648).The age,prevalence rate of stroke and chronic renal insufficiency,baseline level of blood potassium,the rate of oral potassium supplementation and the usage rate of insulin and antibiotics were significantly higher while the levels of estimated glomerular filtration rate(eGFR)and hemoglobin(Hb)were significantly lower in the elderly patients with hypokalemia followed by hyperkalemia than those in the control group(P<0.05).Binary Logistic regression analysis showed that eGFR<60 mL/(min·1.73m^(2))(OR=2.49,95%CI:1.43-4.32),Hb<90 g/L(OR=2.86,95%CI:1.49-5.51),high baseline serum potassium level(OR=1.78,95%CI:1.09-2.92),insulin use(OR=2.57,95%CI:1.47-4.50)and antibiotic use(OR=2.39,95%CI:1.05-5.43)were the risk factors for hyperkalemia after hypokalemia in the elderly patients.Conclusions The elderly patients with hypokalemia have a high risk of hyperkalemia after potassium supplementation,and potassium supplementation should be used with caution in these patients.

关 键 词：老年人 低钾血症 高钾血症 危险因素 

分 类 号：R363.17[医药卫生—病理学]