体外循环心内直视手术补钾用量及方法研究

目的为防治心内直视手术后低血钾室颤心脏骤停，寻求合理的补钾用量及方法。方法对３１６例体外循环手术患者采取３种不同补钾方法及用量：（１）２１例先心病人按＜０．５ｍｍｏｌ／ｋｇ，３０例风心瓣膜病人按０．５～１ｍｍｏｌ／ｋｇ预补钾总量１次加入预充液。（２）９０例按１～１．５ｍｍｏｌ／ｋｇ预补钾总量分２～３次加入预充液。第１次将预补量的６０％加入预充液，余量分次加入氧合器内。（３）１５４例按１．６～２．０ｍｍｏｌ／ｋｇ和２１例风心瓣膜病术前血清钾均＜３．８ｍｍｏｌ／Ｌ，按２．１ｍｍｏｌ／ｋｇ预补钾总量的２／３～４／５加入预充液，余量加入５％ＮａＨＣＯ３内，转流３０分钟后持续氧合器内点滴，视尿量多少调整点滴速度，当排尿＞１０００ｍｌ时，每排尿＞５００ｍｌ追加钾１ｇ。结果方法１组在主动脉开放时血清钾＞４．１ｍｍｏｌ／Ｌ者１９．４％，方法２组主动脉开放时血清钾＞４．１ｍｍｏｌ／Ｌ者为３７．７％者，方法３组主动脉开放时血清钾＞４．１ｍｍｏｌ／Ｌ者９４．９％。结论方法１、２组用量不足方法也不完善，方法３组用量合理，方法较完善

Methodological study and dose of potassium supplement in the open heart surgery undergoing cardiopulmonary bypass

Objective To prevent and treat hypopotassemia effectively in the open heart surgery undergoing cardiopulmonary bypass (CPB) and find a rationale dose and method of potassium supplement. Methods Three different doses and methods for potassium supplement were performed on 316 cases of open heart surgery undergoing CPB. In group A, 21 CHD patients received the potassium supplement of less than 0.5 mmol/kg and 30 RHD cases 0.5 to 1.0 mmol/kg added into preload solution once time. In group B, 90 patients with various cardiovascular diseases were given the potassium supplement of 1.0 to 1.5 mmol/kg added into the preload solution 2 or 3 times. In group C, 154 patients with various cardiovascular diseases underwent the potassium supplement of 1.6 to 2.0 mmol/kg and 21 RHD patients with preoperative potassium concentration less than 3.8 mmol/L given 2.1 mmol/kg potassium supplement (2/3 to 4/5 added into the preload solution, the rest into 5% SB). After the urine volume was more than 1000 ml, 1 g potassium was supplied every 500 ml urine. Results The patients with the serum potassium concentration over 4.1 mmol/L accounted for 19.4 % in the group A, 37.7 % in the group B, 94.9 % in the group C at the aorta unclamped. Conclusion The method for potassium supplement used in the group C was more perfect and the dose was rationale.