ICU低钾血症患者高浓度静脉补钾的临床研究

目的探讨高浓度深静脉微泵补钾治疗危重患者低钾血症的有效性和安全性。方法156例合并低钾血症的危重患者(排除补钾开始前连续3小时每小时尿量<30ml/h,补钾开始前出现急性肺水肿或中心静脉压超过12cmH2O的患者)随机分为治疗组和对照组各78例,治疗组和对照组补钾浓度分别为1341mmol/L(相当于10%的氯化钾溶液)和53.64mmol/L(相当于0.4%的氯化钾溶液),补钾速度治疗组为6ml/h,对照组在保持中心静脉压不超过12cmH2O的条件下单位时间补钾量尽量保持与治疗组相同。密切监测血钾水平、心电图变化、中心静脉压,血钾正常停止补钾。结果两组补钾前、后血钾浓度、补钾治疗时间无统计学差异(P>0.05)。但治疗组与对照组相比,补钾液体量明显减少,有统计学差异(P<0.01)。两组治疗过程中均未发生明显高钾血症、血流动力学变化。两组肾功能对补钾时间无明显影响。结论高浓度深静脉微泵补钾治疗危重低钾血症患者是安全有效的,对合并急性肾损伤但无少尿或无尿的低钾血症患者也可在严密监测下行高浓度深静脉微泵补钾治疗。

A clinical study on intravenous concentrated potassium infusion therapy for hypokalemia in ICU

Objective To investigate the clinical efficacy and safety of intravenous administration of high concentration potassium chloride using micro pumps in critically ill patients with hypokalemia. Methods 156 critically ill patients with hypokalemia （except those with the urine output less than 30ml/h for the first three hours before given potassium and those with acute pulmonary edema or central venous pressure higher than 12cmH2 O） were randomly divided into the treatment group （n = 78） and the control group （n = 78）. Patients in therapy group received 1341mmol/L （10%） potassium chloride at the rate of 6ml/h,while those in the control group received 53.64mmol/L （0.4%） potassium chloride at the infusion rate of the same quantity of potassium chloride with the treatment group hourly on condition that the central venous pressure not more than 12cmH2 O, with the aid of micro pumps. The serum potassium, electrocardiogram and central venous pressure of patients in both groups were monitored strictly. And the potassium infusion was stopped when the serum potassium exceeded or equal to 3.5mmol/L. Results No significant differences were found in the serum potassium before and after therapy and the potassium infusion time between the control group and therapy group （ P 〉0.05）. Potassium infusion brought much less amount fluid in the therapy group than the control group （ P 〈0.01）. All patients tolerated the infusion without evidence of hemodynamic change and hyperkalemia. Renal function did not effect the potassium infusion time in this study. Conclusion Under strictly monitoring, it is safe and effective to infuse intravenous concentrated potassium chloride using micro pumps in critically ill patients with hypokelamia. This strategy can also be administrated in patients with acute renal injury but without oliguria or anuria under careful monitoring.