危重患者高浓度静脉补钾的安全性和疗效研究

目的 探讨高浓度钾微量泵入治疗危重患者低钾血症的安全性及有效性.方法 128例合并低钾血症的危重患者[内生肌酐清除率(CCr)＞0.5 ml/s且每小时尿量＞50 ml]被随机分为治疗组和对照组,各64例.治疗组和对照组补钾浓度分别为1 208 mmol/L(相当于质量分数为9%的KCl溶液)、201 mmol/L(相当于1.5%的KCI溶液),补钾速度相同.均进行严密监测与血钾浓度监测,血钾正常时停止补钾.结果 治疗组和对照组补钾时间比较差异无统计学意义[(15.55±3.22)h比(14.18±4.93)h,P＞0.05];治疗组补钾的液体量明显低于对照组[(124.36±25.79)ml比(680.83±36.70)ml,P＜0.01].两组治疗过程中均未发生明显血流动力学变化、高钾血症或急性心功能不全.两组患者肾功能是否正常对补钾时间无明显影响.补钾前血钾浓度与补钾量有一定相关性(相关系数r=-0.259,P＜0.01).结论 高浓度钾微量泵入治疗危重患者低钾血症可以在短时间内纠正低钾血症,是安全有效的.肾功能轻度异常但无少尿及无尿的患者也可以在严密监测下高浓度补钾.     

氯化钾溶液灌肠法治疗心力衰竭伴低血钾症的护理与观察

目的　寻找心力衰竭患者补钾的方法。方法　将心衰伴中度缺钾住院患者 5 0例分为两组 ,A组静脉输入 5 %葡萄糖溶液或葡萄糖氯化钠溶液 10 0 0ml+10 %氯化钾 2 0ml,B组肠道注入 0 .9%生理盐水 2 0ml+10 %氯化钾 2 0ml,观察两组补钾效果、患者反应及护理人力资源使用情况。结果　A组纠正血钾时间平均为 (8.36± 1.87)h ,2 4h后血钾值平均上升 (0 .32± 0 .0 7)mmol/L ,完成治疗需要时间为 8h ,护理耗时 4 0min ,需 2个班次护士完成 ;B组纠正血钾时间平均为 (3.0 1± 0 .6 9)h ,2 4h后血钾值平均上升 (0 .5 2± 0 .0 7)mmol/L ,完成一日 2次治疗共需约 10min ,2例患者 30min后排便 ,护士可在本班内完成。结论　采用氯化钾溶液灌肠法可显著纠正心衰伴中度缺钾患者的低钾血症 ,补钾速度快 ,患者易于接受 ,护理操作安全、简单。     

Effects of potassium supplementation on the recovery of thyrotoxic periodic paralysis

Potassium supplements have been recommended to hasten recovery and prevent cardiopulmonary complications in patients with thyrotoxic periodic paralysis (TPP). However, this recommendation has not yet been proven efficacious. Thirty-two patients with acute attacks of TPP over a 3-year-period were divided into 2 groups. Group A (n = 12) was a control group treated with normal saline infusion 125 mL/hr only. Group B (n = 20) received intravenous KCl administration at a rate of 10 mmol/hr in normal saline 125 mL/hr. During the attack and for 6 hours after muscle recovery, hemodynamics were continuously recorded and muscle strength and plasma K(+) concentration were measured hourly. The sex, age, muscle strength, thyroid function, biochemical values including plasma K(+) levels, as well as the time from attack to therapy (3.6 +/- 1.6 v 3.3 +/- 1.0 hr) were not significant between the 2 groups. However, recovery time was significantly shorter in the KCl group than the control (6.3 +/- 3.8 v 13.5 +/- 7.5 hr, P < .01). Rebound hyperkalemia greater than 5.5 mmol/L occurred in 40% patients receiving KCl. The dose of KCl administered and peak K(+) concentration were positively correlated (r = 0.85, P < .001). In conclusion, KCl therapy proves to help the recovery of paralysis in TPP associated with rebound hyperkalemia. KCl supplementation should be given as small as possible (<10 mmol/hr) to avoid rebound hyperkalemia unless there are cardiopulmonary complications.     

雾化吸入氯化钾在纠正慢性阻塞性肺疾病病人轻度低钾血症中的应用

[目的]探讨雾化吸入氯化钾在纠正慢性阻塞性肺疾病(COPD)病人轻度低钾血症中的应用。[方法]将90例COPD合并轻度低钾血症病人随机分为A组、B组、C组,每组30例,根据血清钾浓度,A组采用口服补钾,B组采用静脉补钾,C组采用雾化吸入补钾。比较3组病人补钾前后血清钾变化情况及副反应发生情况。[结果]3组病人补钾的效果比较,差异无统计学意义(P>0.05);A组病人胃肠道不适症状发生率高于C组与B组,B组静脉刺激症状发生率高于C组与A组,而C组发生咳嗽,与A组、B组比较,差异无统计学意义。[结论]雾化吸入补钾可改善COPD病人轻度低钾血症且副反应少。     

原发性醛固酮增多症的临床分析

本文对10例原发性醛固酮增多症的临床分析中,肾上腺皮质单侧腺瘤8例,增生1例。一侧腺瘤合并对侧增生1例。10例均有高血压、低血钾、肾上腺定位检查阳性所见,24小时尿钾(8/10)增多、血浆醛固酮水平(6/6)增高,血浆肾素活性(4/6)受抑制。作者还重点对本症的早期诊断及治疗方法的选择进行了探讨。     

美托洛尔缓释片治疗慢性心力衰竭患者的疗效观察

目的：观察美托洛尔缓释片治疗慢性心力衰竭（CHF）患者的疗效。方法：对28例CHF患者在常规治疗的基础上,加用美托洛尔缓释片,并与27例常规治疗组患者进行对照比较,观察1年后患者的心功能、再住院率和死亡率。结果：1年后,美托洛尔缓释片组（治疗组）和对照组比较,心功能改善明显（P〈0.05）;再住院率和死亡率降低（P〈0.05）。结论：美托洛尔缓释片可以改善心功能,降低再住院率和死亡率。     

严重低钾血症患儿快速高浓度补钾的护理

总结了15例严重低钾血症患儿静脉快速高浓度补钾的护理经验,包括：持续心电监护和经皮血氧饱和度监护,严密监测生命体征、尿量并记录;动态观察血气分析及血钾变化;正确使用微量输液泵;加强穿刺部位的护理;观察腹胀及肌张力变化.治疗过程中无1例发生一过性血钾过高、高钾所致的心律失常及其他并发症,提示加强护理快速,高浓度补钾治疗严重低钾血症患儿安全有效.     

低钾型周期性瘫痪与肌酶及红细胞内钾的关系

【目的】探讨低钾型周期性瘫疾与血清肌酶及红细胞内钾的关系。【方法】分析36例低钾型周期性瘫疾病人的临床资料,并对该组病人和30例健康对照者血清钾、血清肌酶、红细胞内钾进行检测及比较分析。【结果】36例中。血清钾均低于正常,肌酸激酶（CK）升高25例。与对照组比较差异非常显著（P〈0．01）;天冬氨酸转氨酶（AST）升高18例,与对照组比较差异非常显著（P〈0．01）;红细胞内钾降低29例,与对照组比较差异非常显著（P〈0.01）。【结论】低钾型周期性瘫痪伴有血清肌酶升高及红细胞内钾的降低。     

氯沙坦钾对原发性高血压合并高尿酸血症患者血尿酸代谢的影响

目的评价氯沙坦钾治疗原发性高血压合并高尿酸血症患者的临床疗效。方法随机选择原发性高血压合并高尿酸血症患者66例,给予氯沙坦钾50 mg/d为起始剂量,根据血压及血尿酸水平调整使用剂量,在治疗前1 d,治疗后6、12周分别测量血压及血尿酸水平,观察入组患者的血压、尿酸及不良反应情况。结果入选患者在治疗前后血压均下降平稳,达至治疗目标值,治疗6周后血尿酸有不同程度的降低,12周后血尿酸均降至正常范围。整个治疗过程中未出现干咳、低血压、电解质紊乱等不良反应,未发现肝肾功能损伤及糖脂代谢紊乱。结论氯沙坦钾治疗原发性高血压安全、有效,不良反应发生率低,更能有效降低血尿酸水平,有助于控制痛风发作。     

欧洲心脏学会2004年年会临床资料简介

就欧洲心脏学会 2 0 0 4年年会的有关临床资料作一简介。     

急性心肌梗死早期低血钾与心衰的关系

目的 探讨急性心肌梗死（AMI）患者早期低钾血症的变化以及与心力衰竭的关系。方法收集200例急性心肌梗死的患者,发病时间小于24小时,所有患者均为首次入院。根据血钾浓度分为低钾血症组和正常血钾组,其中低钾血症组又分为重度低钾组（〈2．50mmol／L）、中度低钾组（2．51mmol／L-3．0mmool／L）和轻度低钾组（3．01-3．50mmol／L）。所有患者予以常规积极治疗,观察心力衰竭发生情况。结果AMI患者低钾血症的发生率为73．5％,低钾血症组心力衰竭的发生率为51．7％,明显高于正常组（22．6％）,其中重度低钾组心衰的发生率78．2％,中度低钾组为58．3％,轻度低钾组为38．9％。结论急性心肌梗死早期易出现低钾血症,并且随着血钾浓度的降低,心力衰竭的发生率也明显增高。     

The effects of thiamine supplementation on patients with heart failure: A systematic review and meta-analysis of randomized controlled trials

BackgroundMicronutrients can benefit patients with heart failure (HF). Thiamine is a critical vitamin, while the impact of thiamine supplementation on patients with HF remains unclear. Systematic review and meta-analysis were conducted to evaluate the effects of thiamine supplementation on clinical outcomes in patients with HF.MethodsDatabases including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and CNKI were searched from inception to June 29th 2022. Randomized controlled trials (RCTs) comparing thiamine supplementation with placebo were included. Meta-analysis was conducted with the software Review Manager 5.4. The quality assessment was performed according to Cochrane Risk of Bias Tool 2.0.ResultsEight studies including 384 patients were included in this review. The results of overall systematic review showed no benefit of thiamine supplementation in HF patients. Compared with the control group, the experimental group had no statistically significant improvements in LVEF (Mean Difference, − 0.19; 95 % CI, − 2.78 to 0.96; I² = 49 %; P = 0.10) in patients with chronic heart failure (CHF). Other outcomes including NYHA class, BNP or NT-proBNP, thiamine status, symptom changes, and quality of life were not improved by thiamine supplementation in CHF patients. Similarly, no improvements in clinical outcomes were found in patients with acute heart failure (AHF) in the studies included.ConclusionsThis systematic review and meta-analysis found no evidence to support the effects of thiamine supplementation in patients with HF, though thiamine supplementation is promising in improving cardiac functions, thiamine status and relieving HF-related symptoms. More well-designed RCTs with large sample sizes are required.     

充血性心力衰竭时室性心律失常的临床研究

回顾性分析278例充血性心力衰竭患者室性心律失常的临床意义。结果表明,随着心功能的恶化,低血钾水平更易发生室性早搏(P<0.001);扩张型心肌病对低血钾高度敏感,与其它病因组(冠心病、高血压和风心病组)比较有显著的统计学意义(P≤0.01)。建议在治疗充血性心力衰竭时应密切注意电解质的动态平衡,适量的补充钾盐和镁剂可以减少室性心律失常的发生和改善心功能。     

Effects of potassium supplementation on insulin binding and insulin action in human obesity: protein-modified fast and refeeding

To investigate the role of potassium deficiency in the development of glucose intolerance during caloric deprivation, potassium balance was maintained within normality with oral potassium supplementation in a group of obese subjects who underwent protein-modified fast and the results of the study of carbohydrate metabolism (oral glucose test, insulin receptors on monocytes and peripheral glucose utilization as assessed by euglycaemic clamp) were compared with those obtained in a group of obese subjects admitted to protein-modified fast without potassium supplementation. Caloric deprivation without oral potassium supplementation was followed by a negative potassium balance and a decrease of serum potassium levels; a decrease of the peripheral levels of insulin along with an increase in insulin receptors and a striking reduction of peripheral glucose utilization were also observed. The maintenance of normal potassium balance and normal serum potassium levels with oral potassium-chloride supplementation was associated with higher peripheral levels of insulin (P less than 0.01) and improvement of peripheral glucose utilization (P less than 0.01) whereas the binding of insulin to monocytes was unchanged. The data suggest that potassium depletion during protein-modified fast causes a decrease of the peripheral levels of insulin and a resistance to insulin action at the postreceptors sites which is reversed by potassium supply.     

N-末端B型脑钠肽检测在心力衰竭中的应用

目的评价N-末端B型脑钠肽(NT-proBNP)检测在心力衰竭(以下简称心衰)诊断中的应用价值。方法应用ReLIA公司出品的SST-2型多功能免疫检测仪测定NT-proBNP。将140例患者分组为心衰组和非心衰组,同对照组比较。结果心衰组患者血浆的NT-proBNP水平显著高于非心衰组及正常对照组,NT-proBNP水平与NYHA分级具有正相关性。结论BNP对于心力衰竭的诊断、鉴别诊断及预后判断甚至指导治疗均有重要价值。     

住院患者临床检测低血钾而无低钾症状的原因分析

目的探讨住院患者实验室检测低血钾而无临床低钾症状的原因,为消除临床诊断和治疗误区提供新思路及实验依据。方法对2010年3月至2011年2月该院750例血钾小于3.0mmol/L的住院患者进行回顾性分析。根据患者当时是否有低钾症状分为两组,对6个临床相关因素进行分析比较;另就高温下（30℃）肝素钠抗凝血对检测结果的影响做实验分析。结果 750例患者中495例有临床低钾症状,其发生率为66.0%;255例无低钾症状,发生率为34.0%,两组患者在年龄、季节、病区、心电图检查及血钾水平比较差异均有统计学意义（P〈0.05）;高温下肝素钠抗凝血放置2h即对离子选择性电极间接法检测钾离子有负干扰,且超出允许总误差。结论住院患者实验室检测低血钾而无临床低钾症状发生的原因与多种因素有关,临床应加强对有重病、慢性病的老年患者血钾的监测,早期诊断和治疗,预防患者发生无症状低血钾,夏季住院患者使用离子选择性电极间接法检测肝素钠抗凝血浆钾离子标本应及时送检,并使标本始终处于22～25℃,以确保检验结果对临床诊断的有效性。     

水果补钾预防PCI围手术期低钾血症的效果观察

目的探讨水果补钾预防经皮冠状动脉支架植入术(percutanous coronary intervention,PCI)围手术期低钾血症的效果。方法选择2011年7～12月本院收治的90例低钾血症拟行PCI的冠心病患者,在常规口服药物补钾治疗基础上,给予吃橙子和香蕉,每天各吃500g,分早、中、晚3次进食,持续至术前。观察患者入院时及手术当天、术后第1d、第3d血钾情况。结果患者术前口服水果补钾时间为12～45h,平均(28.84±11.70)h;患者手术当天及术后第1d、第3d血钾水平比入院当天明显升高(均P<0.05),而且维持在正常水平。结论进食香蕉和橙子可帮助患者快速纠正低钾血症,有效预防PCI围手术期低钾血症。     

养心康和保心康治疗充血性心力衰竭的临床研究

目的 :观察中药复方制剂养心康和保心康治疗充血性心力衰竭的疗效。方法 :92例患者按中医辨证分为气阴虚型 ( 60型 )和气阳虚型 ( 3 2例 )。两型分别随机分为治疗组和对照组 ,一般治疗相同。气阴虚型治疗组 ( 4 0例 )加服养心康 ,气阳虚型治疗组 ( 2 2例 )加服保心康 ,两型对照组均加服安慰剂 ,均连服药 2周。结果 :两型治疗组证候疗效总有效率 91.9% ,对照组为2 9 .3 % ,有显著差异 (P <0 .0 1) ;心功能疗效总有效率 ,气阴虚型为 80 % ,气阳虚型为 95 .4 %。结论 :养心康和保心康对充血性心力衰竭有良好的疗效。     

两种利尿剂不同比例联合应用对慢性心力衰竭患者血钾的影响

目的探讨不同比例保钾利尿剂与排钾利尿剂联合应用对慢性心力衰竭患者血钾的影响。方法选取住院心力衰竭患者298例,其中包括单纯心力衰竭者179例,心力衰竭合并肾功能不全者119例。单纯心力衰竭组及心力衰竭合并肾功能不全组分别采用随机数字表法分为A、B及C、D四组,均在常规心力衰竭治疗基础上给予排钾利尿剂呋塞米和保钾利尿剂螺内酯联合治疗,A、B、C、D四组呋塞米与螺内酯口服剂量比例分别为1∶1、1∶2、1∶1、1∶2,并排除饮食、基础血钾对血钾的干扰,监测血钾含量及肾功能。结果 A、B、C、D四组低钾血症的发生率分别为66.3%、4.4%、10.2%、0.0%,四组高钾血症的发生率分别为0.0%、1.1%、8.5%、51.7%,四组再入院率分别为9.0%、4.4%、11.9%、13.3%;单纯心力衰竭组中B组较A组低血钾发生率较低,差异有统计学意义(χ~2=75.047,P0.01);心力衰竭合并肾功能不全组C组较D组高血钾发生低,差异有统计学意义(χ~2=26.301,P0.01)。心力衰竭合并肾功能不全组较单纯心力衰竭组患者的总再入院率较高(12.6%比6.7%),但差异无统计学意义(χ~2=3.021,P=0.082)。合并肾功能不全的心力衰竭亚组分析结果显示血钾水平与患者血肌酐水平具有正相关性(Pearson相关系数为0.967,P0.01)。结论在正常饮食、肾功能和基础血钾情况下,呋塞米与螺内酯按1∶2联合应用对心力衰竭患者的血钾含量影响较小;而当治疗合并肾功能不全的心力衰竭患者时,应视肾功能不全的轻重调整呋塞米与螺内酯的比例。