潜在器官捐献供体重度低钾血症8例临床总结并文献复习

Clinical summary of 8 cases of severe hypokalemia from potential organ donors and review of literature

目的:探讨潜在器官捐献供体重度低钾血症进行临床补钾的安全性和有效性。方法:收治潜在器官捐献供体重度低钾血症8例,病因为自发性脑出血及重型颅脑损伤,格拉斯哥昏迷评分3分,符合脑死亡判定标准4例,皆采用静脉高浓度补钾为主,口服补钾为辅的治疗措施。观察血钾和心电图变化。结果:经过补钾措施干预后,血钾恢复正常,其中后来出现高钾血症3例,心脏骤停1例,但抢救成功。心电图出现窦速1例,病情恶化1例,持续高钾,家属最终放弃治疗。结论:潜在器官捐献供体重度低钾血症影响因素较多,补钾处理应个体化,严重低钾有致命性心律失常风险,因此加强血钾和心电图监测频次,以确保补钾有效性和避免高钾血症。

Objective: Explore the safety and effectiveness of the potential organ donor for the clinical use of potassium replacement for hypokalemia.Methods:8 cases of the potential organ donors with severe hypokalemia were selected,the causes were spontaneous intracerebral hemorrhage and severe craniocerebral injury.The Glasgow coma score was 3 and 4 patients met the brain death score.All patients were treated with intravenous high concentration potassium supplementation supplemented by oral potassium supplementation.We observed the changes of serum potassium and electrocardiogram.Results:After the intervention of potassium supplement,the serum potassium returned to normal,including 3 cases of hyperkalemia and 1 case of cardiac arrest,but the rescue was successful.ECG showed sinus tachycardia in 1 case,deterioration in 1 case,persistent high potassium,and the family finally gave up treatment.Conclusion:The factors affecting the potential organ donor with severe hypokalemia were complex.Potassium supplementation should be individualized.Severe hypokalemia has a risk of fatal arrhythmia.Therefore,the frequency of serum potassium and electrocardiogram monitoring should be strengthened for ensuring effective potassium replacement and avoiding hyperkalemia.