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1.
P. Peigh A. Fiore K. Naunheim G. Kaiser D.G. Pennington L. McBride V. Willman H. Barner 《European journal of cardio-thoracic surgery》1994,8(12):635-639
The purpose of this study was to determine if the addition of potassium to reinfusion cold blood cardioplegia (CBC) offers an advantage over cold blood alone. Forty patients matched for age, left ventricular function, extent of coronary disease and number of vessels bypassed were prospectively randomized. Each patient received an initial dose of CB C (10 cc/kg) with potassium. Group I patients (n=23) received subsequent infusions of CBC (5 cc/kg) containing potassium while Group II patients (n=17) received cold blood only. The cross-clamp time, mean infusate volume and temperature were not significantly different in the two groups. Following reperfusion, the cardiac index and the CPK isoenzyme release at 0.5, 1, 8, and 12 h after cross-clamp release were not significantly different between the groups. The postoperative appearance of new Q-waves, inotropic agent requirement, and reversal of the lactate dehydrogenase (LDH) isoenzyme ratio were also not significantly different in the two groups. The study demonstrated that following initial arrest with potassium, cold blood is equally as effective as potassium blood cardioplegia in protecting the ischemic myocardium. 相似文献
2.
本文观察了电刺激迷走神经对家兔商血钾时心室肌单相动作电位(MAP)及单个心室肌细胞跨膜电位(TMP)的影响。结果表明,迷走神经刺激可以改善高血钾引起的心室内传导阻滞,使单相动作电位振幅(MAPA)、单相动作电位0相最大上升速率(MVmax)增加,单相动作电位时程(MAPD)延长,亦使单个心室肌细胞静息电位(RP)、动作电位振幅(APA)和0相最大上升速率(Vmax)增加,动作电位时程(APD)延长。另外,两种记录方法在同一部位的MAPD与APD完全一致。 相似文献
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高钾时心室肌电——机械交替活动的分析 总被引:1,自引:0,他引:1
高钾(12mmol/L)条件下,突然增快刺激频率(1HZ-4Hz),豚鼠乳头肌发生两轮2:1电-机械交替(EMA)。第一轮EMA历时约22-30s宽的动作电位(AP)马低的收缩力(Fc)相对应。间隔性AP脱落期发生在两轮EMA之间,历时约4-6min。第二轮EMA期间,高宽的AP与高的Fc相对应。AP交替消失时Fc交替也随之消失。第二轮EMA历时22-34min(26±5min,n=7),奎尼丁(1μg/ml)显著增强第二轮EMA,异搏定(0.5μg/ml)则相反。提示高钾诱发的EMA可能与Na+,Ca2+离子流有关。 相似文献
4.
目的:分析急、慢性肾衰竭并高钾血症的临床表现和护理策略。方法:回顾性分析10年来采用血液透析等抢救肾衰竭并高钾血症病人102例,共并发高钾血症457例次的临床过程。结果:456例次的临床症状改善,血清钾浓度降至正常范围,临床症状消失,1病例抢救无效死亡。抢救成功率99.0%。结论:护士应有高度的责任心、敏锐的观察力,在透析前应做好充分准备,保证患者顺利完成血液透析。血液透析疗法是治疗高钾血症最有效的方法,使用含钾3.0~3.5mmol/L浓度的碳酸氢盐透析液进行透析,对降低高钾血症效果确切,可靠安全。血液透析治疗早期,不应作单纯超滤脱水治疗。透析早期仍有因高钾而致心跳骤停等危险,应随时准备抢救。 相似文献
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Seyed Mehrdad Hamrahian Tibor Fülöp 《The American journal of the medical sciences》2021,361(1):106-110
Potassium is the most important intracellular cation and the kidneys play a pivotal role in potassium homeostasis. Potassium disorder is a common electrolyte abnormality and it increases the risk of death from any cause, particularly cardiovascular events. Hyperkalemia is a common electrolyte abnormality encountered post organ transplantation. The etiology is multifactorial, and includes drugs such as calcineurin inhibitors. In certain regards, the clinical picture of post-transplantation hyperkalemia and hypertension resembles that of Gordon syndrome or familial hyperkalemic hypertension, a disorder characterized by over activity of thiazide-sensitive sodium chloride cotransporter. Effective and safe management of chronic hyperkalemia can be challenging in this special patient population. Despite the significant short-term and long-term side effects, fludrocortisone (a potent synthetic oral mineralocorticoid receptor agonist) has emerged as the default drug of choice for treatment of refractory hyperkalemia in many organ transplant recipients. However, the long-term efficacy and safety of fludrocortisone for management of hyperkalemia in organ transplant recipients remains unknown. This review discusses potassium homeostasis, including the role of the kidneys, and focuses on calcineurin inhibitor-induced hyperkalemia and on the under-appreciated role of thiazide-type diuretic use in management of hyperkalemia and hypertension. We present an illustrative case of post-transplantation hyperkalemia and hypertension with relevant literature. 相似文献
8.
《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2022,42(4):448-459
IntroductionPatients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns.ObjectivesTo determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment.Secondary objectivesTo determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia.Material and methodsA single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall.ResultsAt the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m2 (5.4) in men and 26.96 kg/m2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group.ConclusionsMalnutrition is not exclusively an intake deficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease. 相似文献
9.
《Clinical neurophysiology》2021,132(12):3125-3135
ObjectiveUremic myopathy is a condition seen in end-stage renal disease (ESRD), characterized by muscle weakness and muscle fatigue, in which the pathophysiology is uncertain. The aim of this study was to assess the role of abnormal serum constituents in ESRD patients by relating them to the excitability properties of the tibialis anterior muscle, at rest and during electrically induced muscle activation, by recording muscle velocity recovery cycles (MVRC) and frequency ramp responses.MethodsEighteen ESRD patients undergoing hemodialysis were evaluated by blood sample, MVRC, and frequency ramp (before and near the end of dialysis treatment), quantitative electromyography, and nerve conduction studies. Patients were compared to 24 control subjects.ResultsIn patients, muscle relative refractory period, early supernormality, late supernormality after 5 conditioning stimuli, and latency of the last of 15 and 30 frequency ramp pulses were strongly associated with potassium levels (p < 0.01), showing depolarization before and normalization in the end of hemodialysis.ConclusionsIn ESRD patients, the muscle membrane is depolarized, mainly due to hyperkalemia.SignificanceSince normal muscle fatigue has been attributed to potassium-induced depolarization, it seems likely that this mechanism is also a major cause of the exaggerated muscle fatigue and weakness in ESRD patients. 相似文献
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