甲亢合并低钾周期性麻痹的心电图改变

由于高甲状腺素与低钾血症影响,可引起心电图的多种变化,本文观察15例甲亢并低钾周期性麻痹的心电图变,并作分析于下。 15例甲亢诊断明确,测血清钙正常,排除原发性醛固酮增多症和肾小管性酸中毒等引起的低钾血症。在病人麻痹时测血钾同做心电图。血钾浓度为3.2～3.5mmol/L4例,1.7～3.2mmol/L11例。T_3 3.3～3.6μg/L,T_421     

以低钾型周期性麻痹为首发表现的男性甲亢11例报告

甲亢合并低钾周期性麻痹，可与甲亢同时存在或发生于甲亢起病之后，当甲状腺功能恢复正常时，周期性麻痹也消失［‘］。我院自1974～1996年收治男性甲亢11例，均以周期性麻痹为首发表现。现报告如下：临床资料1．病例选择：11例均为男性．年龄22～57岁，平均37．5岁。均以低钾型周期性麻痹为首发表现，病程6月～10年，平均27月。2．诊断依据：（1）有甲亢及周期性麻痹的症状和体征；（2）血钾1．8～；．4rnmol／L，平均2．6mmol／L；（3）心电图示低钾血症；（4）血x、又高于正常；（5）血压、尿常规均正常。3．发病诱因：发作前多次酗酒者…     

甲亢合并周期性麻痹的诱因分析及防治护理对策

目的：分析甲亢合并周期性麻痹的诱因，探讨其防止对策，减少甲亢周期性麻痹的发生。方法：回顾性分析我院收治的67例甲亢周期性麻痹患者，观察诱发甲亢周期性麻痹的临床因素，并提出相关防治对策。结果：患者血钾、年龄、性别、甲亢遗传病史、劳累、受凉和酗酒与甲亢合并周期性麻痹发生密切相关（P〈0．05）。结论：对于合并周期性麻痹症状的甲亢患者应密切注意患者血钾变化，及时纠正低钾血症，并加强患者日常饮食、生活、心理方面的护理与防治，避免周期性麻痹发作的诱因，预防周期性麻痹的反复发作。     

以周期性麻痹为主要表现的甲亢23例分析

目的 探讨周期性麻痹甲亢的临床特点.方法 分析23例周期性麻痹甲亢病例的临床表现及辅助检查结果 .结果 血清钾3.0-3.5 mmol/L 10例,2.5-2.9 mmol/L 6例,2.0-2.4 mmol/L 3例,低于1.5-1.9 mmol/L 4例.结论 周期性麻痹的甲亢应引起临床重视;诊断明确后在及时补钾的同时应尽快使用抗甲状腺药物;症状控制后继续积极治疗原发病乃是防止甲亢性周期性麻痹再发的关键;高温环境、高糖饮食、疲劳、激烈活动可诱发周期性麻痹的发作,应注意避免.     

甲亢合并周期性麻痹35例临床分析

目的　探讨甲亢合并周期性麻痹的临床特点。方法　对 3 5例甲亢合并周期性麻痹患者的临床资料进行分析。结果　甲亢合并周期性麻痹患者男女之比为 3 3∶2。平均发病年龄 3 6.5岁。麻痹发作时血钾范围 1.5～ 3 .1mmol/L。劳累、过食是其发作的最常见诱因。补钾后病情快速缓解。抗甲亢治疗后预后良好。结论　甲状腺激素过多是低钾性周期性麻痹的发病基础。及早控制甲亢 ,避免劳累对预防周期性麻痹发作具有重要意义 ,对周期性麻痹患者应常规行甲状腺功能检查。     

甲亢性周期性麻痹26例临床分析

目的:探讨甲亢性周期性麻痹的临床特点。方法:26例周期性麻痹甲亢患者的临床表现及辅助检查结果。结果:血清钾3.0～3.5mmol/L12例,2.5～2.9mmol/L7例,2.0～2.4mmol/L3例,低于1.9mmol/L4例。结论:甲亢性周期性麻痹以年轻男性多发,应引起临床重视,补钾可迅速改善症状,补钾的同时尽早抗甲亢治疗,糖皮质激素治疗需进一步观察。     

甲亢合并周期性麻痹12例临床分析

目的：探讨甲状腺机能亢进症（甲亢）合并周期性麻痹的临床特点和治疗方法。方法：回顾性分析12例甲亢合并周期性麻痹患者的临床资料。结果：12例患者均出现对称性下肢软瘫,发作时查血钾低于正常,经补钾及甲亢治疗后症状缓解。结论：甲亢合并周期性麻痹患者以青年男性为主,常合并低钾血症,积极补钾的同时合理治疗甲亢是行之有效的手段。     

甲亢合并周期性麻痹的诱因分析及防治护理对策

目的:分析甲亢合并周期性麻痹的诱因,探讨其防止对策,减少甲亢周期性麻痹的发生。方法:回顾性分析我院收治的67例甲亢周期性麻痹患者,观察诱发甲亢周期性麻痹的临床因素,并提出相关防治对策。结果:患者血钾、年龄、性别、甲亢遗传病史、劳累、受凉和酗酒与甲亢合并周期性麻痹发生密切相关(P<0.05)。结论:对于合并周期性麻痹症状的甲亢患者应密切注意患者血钾变化,及时纠正低钾血症,并加强患者日常饮食、生活、心理方面的护理与防治,避免周期性麻痹发作的诱因,预防周期性麻痹的反复发作。     

甲亢合并周期性麻痹的诱因分析及防治护理对策探讨

目的:探讨甲亢合并周期性麻痹的诱因并分析防止护理对策.方法:选择我院收治的76例甲亢合并周期性麻痹患者的临床资料进行回顾性分析,分析诱发甲亢合并周期性麻醉的因素,有针对性的进行防治护理.结论:密切观察甲亢患者的血钾变化,及时纠正低钾血症,做好疾病的防治工作,加强患者日常生活、饮食及心理等方面的护理,可有效的预防周期性麻痹的发作.     

52例甲亢并低钾性周期性麻痹临床分析

目的对甲亢并低钾性周期性麻痹临床治疗效果进行分析。方法现对该院52例甲亢合并低钾周期性麻痹的住院患者临床资料进行回顾性分析。所有患者均予口服及静脉滴注补充氯化钾,10％氯化钾10～20mL,3～4次／d口服;对血钾低于3．2mmol／L的患者另加静脉补钾,用5％葡萄糖注射液或生理盐水500mL加入10％氯化钾1．5g静脉滴注。人选患者经确诊甲亢后后给予每日甲巯咪唑10～30mg或丙基硫氧嘧啶100～300mg口服抗甲状腺治疗,心率快者给予心得安10—30mg／d。结果该组所有52例患者经治疗,低钾血症均得到纠正,肌无力症状完全缓解,四肢肌力均恢复至5级。结论该研究认为甲亢并低钾性周期性麻痹发病主要是由甲状腺激素引起。在治疗该病时,不能单纯的根据临床症状进行诊断,对于病情一再复发者,不仅要考虑周期性麻痹,还要进一步鉴别病症的原发或继发性质。     

甲状腺功能亢进合并周期性麻痹18例临床分析

目的 探讨甲状腺功能亢进合并周期性麻痹的临床特点和有效地治疗方法。方法 回顾性分析了18例甲状腺功能亢进合并周期性麻痹患者的临床资料。结果 本组患者发病时均有不同程度的对称性下肢或四肢软瘫，17例伴有血钾降低，18例FT3，FT44均高于正常。结论 补钾治疗后可迅速改善症状，联合抗甲状腺治疗是防止甲状腺功能亢进合并周期性麻痹复发的重要措施。     

Thyrotoxic periodic paralysis. A case report

Thyrotoxic hypokalemic periodic paralysis (TPP)--a rare complication of thyrotoxicosis and a medical emergency--is characterized by recurrent episodes of muscle weakness and hypokalemia associated with hyperthyroidism. We report a case of TPP in a 38-year-old white Lebanese male. The patient suffered from severe muscle weakness of the upper and lower limbs. His blood tests revealed hypokalemia (k: 2.4 mEq/L), low thyroid-stimulating hormone TSH (0.001 microIU/mL) and normal levels of thyroid hormones. The thyroid scan showed a hot nodule. His paralysis resolved with IV potassium. The patient was treated with propranolol and radioactive iodine with complete remission of the hyperthyroidism and the paralysis. A discussion of the clinical and pathophysiological features and treatment of TPP is presented.     

低钾型周期性瘫痪伴肌酸激酶升高26例临床分析

目的探讨低钾型周期性瘫痪血清肌酸激酶（CK）水平与低血钾的关系。方法回顾性分析26例伴有CK水平升高的低钾型周期性瘫痪患者的临床和辅助检查资料,观察其血清CK水平与低血钾的关系。结果 26例患者的CK水平均有不同程度的升高,血清钾水平最低者（钾浓度〈2.0mmol/L）CK水平升高最为明显。总体上CK水平与血清钾浓度呈负相关。结论部分低钾型周期性瘫痪患者确实可伴有血清CK水平的升高,特别以重度低血钾者为明显。     

Rhabdomyolysis associated with hypokalaemic periodic paralysis of renal tubular acidosis

Two cases of hypokalaemia with serum potassium levels of 1.4 mmol/L and 1.9 mmol/L causing severe periodic paralysis since childhood are presented. There were associated with muscular aches and markedly raised muscle enzymes suggesting massive rhabdomyolysis. These abnormalities were due to renal tubular acidosis with markedly acidic arterial pH. The hypokalaemia and rhabdomyolysis responded to potassium and bicarbonate replacement. We postulate these patients had sporadic distal type of renal tubular acidosis and that the hypokalaemia and acidosis had caused the rhabdomyolysis.     

惊恐障碍误诊为低钾性周期性瘫痪的临床分析

目的探讨惊恐障碍和低钾性周期性瘫痪患者的临床鉴别诊断方法以减少误诊。方法选择2008年1月至2011年1月该院急诊科以低钾性周期性瘫痪收治的惊恐障碍患者7例(惊恐障碍组),同期本院收治的低钾性周期性瘫痪患者192例(低钾周期性瘫痪组),比较两组患者临床资料。结果惊恐障碍组患者平均肌力[(3.7±0.81)级]、平均血钾[(3.1±0.56)mmol/L]与低钾性周期性瘫痪组平均肌力、平均血钾分别为[(2.4±0.84)级、(2.3±0.83)mmol/L]比较,差异有统计学意义(P<0.05)。结论对临床急性发病的肢体无力伴有明显焦虑情绪者,应当考虑到惊恐障碍的可能性以减少误诊。     

20例低血钾型周期性麻痹患者临床和病理分析

目的探讨低血钾型周期性麻痹（hypokalemie period paralysis,HOPP）患者的临床及骨骼肌病理特点。方法回顾性分析2005年9月—-2012年12月在河北医科大学第三医院做骨骼肌活检的HOPP患者20例,均行血钾、肌酸激酶、心电图及甲状腺功能检查。结果20例患者中,原发性HOPP组16例,甲状腺功能亢进合并HOPP组（TPP组）4例。TPP组的起病年龄较原发性HOPP组晚,（42．75±9．36）岁135（24．81±5．49）岁（P〈0．01）;原发性HOPP组与TPP组分别有43．75％（7／16）和25．00％（1／4）的患者存在血清肌酸激酶水平异常增高;2组患者血钾水平差异无统计学意义,（2．82士0．30）mmol／L125（2．58±0．13）mmol／L）;20例患者中,有8例（40．00％）骨骼肌活检见肌纤维胞浆中存在典型“管聚集”现象,其中原发性HOPP组7例,TPP组1例。结论低血钾型周期性麻痹“管聚集”的发病率为40．00％,8例患者存在肌纤维网结构紊乱、“管聚集”现象,原发性HOPP组“管聚集”现象较TPP组更常见;原发性HOPP组发病年龄较早。     

低钾性周期性麻痹临床特点分析

目的：探讨低钾性周期性麻痹的临床特点, 比较原发性低钾周期性麻痹与甲状腺毒症继发周期性麻痹两组患者的异同点。方法: 北京大学第一医院1996年12月至2008年12月住院治疗的低钾性周期性麻痹患者44例, 回顾性分析其临床资料。结果: 原发组和甲状腺毒症继发组各22例, 两组患者共同的特点: (1)均好发于青壮年男性; (2)主要临床表现均为肢体活动障碍和乏力, 大部分病例以反复多次发作为主; (3)部分病例（40.9% ~ 68.2%）发病有明显诱因, 诱因以饱餐、喝甜饮料和剧烈运动最常见; (4)发病时, 两组患者血钾水平均明显低于正常水平; (5)原发组与甲状腺毒症继发组分别有20%和25%的患者肌酸激酶明显升高, 补钾治疗后较快恢复正常, 乳酸脱氢酶及α羟基丁酸脱氢酶均正常; (6)补钾剂量与发病时血钾水平无相关性。两组患者的不同点主要表现为: (1) 甲状腺毒症继发组患者有高代谢症状, 甲状腺功能提示T3、T4升高和促甲状腺激素（TSH）降低, 原发组患者无此类症状, 其甲状腺功能正常; (2)甲状腺毒症继发组血钾水平显著低于原发组［(2.25±0.67) vs (2.78±0.49)mmol/L, P=0.007］; (3)甲状腺毒症继发周期性麻痹较原发性低钾性周期性麻痹在补钾治疗过程中更容易出现反跳性高钾血症。结论: 低钾性周期性麻痹有其临床特点, 早期诊断及时补钾治疗预后较好。补钾时不能仅根据发病时血钾水平决定补钾剂量, 应密切监测血钾水平。甲状腺毒症继发周期性麻痹在补钾治疗过程中更容易出现反跳性高钾血症, 在补钾治疗时应当密切监测血钾, 并积极根治甲状腺毒症。     

急性心肌梗死患者梗死部位和冠状动脉病变与预后的关系

摘要：目的探讨急性心肌梗死合并低血钾患者梗死部位、冠状动脉病变及预后的关系。方法将212例急性心肌梗死患者发病后血钾水平分为两组：A组（低血钾组,血钾〈3．5mmol／L）;B组（血钾正常组,血钾3．5～5．5mmol／L）。将两组的梗死部位、并发症、预后及冠状动脉造影结果进行比较分析。结果急性心肌梗死患者低血钾者97例（占45．8％）,梗死相关血管近端病变53例（占59．8％）、梗死相关血管为前降支的45例（占46．4％）、严重心律失常41例（占42．3％）、心力衰竭27例（占27．8％）梗死后心绞痛32（占33％）,与血钾正常组分项比较差异显著（均为P〈O．05）。结论急性心肌梗死合并低血钾的梗死相关血管多为近端病变,梗死相关血管多为前降支,预后较差。     

Thyrotoxic periodic paralysis in Mexican mestizo patients: a clinical, biochemical and HLA-serological study

BACKGROUND: Thyrotoxic periodic paralysis (TPP) is characterized by episodes of neuromuscular weakness occurring in the context of hypokalemia and hyperthyroidism and has been predominantly described in Oriental populations. Whereas it is uncommon in Caucasians and Blacks, TPP does occur in individuals of Native American descent. The objective was to analyze the clinical, biochemical, and HLA characteristics of a group of Mexican mestizo patients with TPP. METHODS: The sample was comprised of 14 men with TPP diagnosed since January 1990, based on one or more episodes of flaccid paralysis, accompanied by hypokalemia and occurring in the context of clinical and biochemical hyperthyroidism. Eight were available for HLA testing. RESULTS: Hyperthyroidism was diagnosed before the development of periodic paralysis in five of the patients, whereas in six it occurred afterward. The severity of paralysis did not correlate with the degree of either hypokalemia or hyperthyroidism. An increased frequency of HLA-DR3 was found in Graves' patients without paralysis but not in those with paralysis, as compared to the general population. CONCLUSIONS: TPP is more common than previously thought in Mexicans, in whom it behaves as in other Native American groups. The lack of HLA-DR3 association in Graves' patients with TPP is interesting, but at the moment has no pathophysiological implications.     

Hydrochlorothiazide-amiloride versus hydrochlorothiazide alone for essential hypertension: effects on blood pressure and serum potassium level

In a double-blind randomized controlled trial the effects on the blood pressure and the serum potassium concentration of hydrochlorothiazide-amiloride hydrochloride (Moduret) and hydrochlorothiazide alone were compared in 266 adults who were normokalemic and had a diastolic blood pressure greater than 95 mm Hg at the time of entry into the study. The mean ages (52.2 and 53.8 years) and the proportions of men (66% and 56%) in the groups given the combination drug and hydrochlorothiazide alone respectively were similar. In the group given the combination drug the mean blood pressure, measured while the patients were supine, and the mean serum potassium level fell significantly, from 156/99 to 138/88 mm Hg and from 4.23 to 3.91 mmol/L, after 8 weeks of treatment. In the other group both measures also fell significantly, the blood pressure from 157/99 to 138/87 mm Hg and the potassium level from 4.16 to 3.69 mmol/L. The proportions of patients in the two groups with hypokalemia (14% and 29% respectively), defined as a serum potassium level below 3.5 mmol/L, differed significantly (p = 0.0026), whereas the proportions with a potassium level exceeding 4.5 mmol/L (4.5% and 3.9% respectively) were similar. Thus, the combination drug reduced the blood pressure to the same extent as hydrochlorothiazide alone but significantly less often caused hypokalemia. In light of growing concerns about the cardiovascular complications of hypokalemia, hydrochlorothiazide-amiloride appears preferable to hydrochlorothiazide alone for the treatment of some patients with hypertension.