外科病人红细胞内钾、钠变化及其临床意义

CHANGES OF SODIUM AND POTASSIUM IN RED CELL AND THEIR SIGNIFICANCE IN SURGICAL PATIENTS

作者对20名正常人和60名外科病人测定了红细胞内钾、钠及钾/钠比值。20名正常人红细胞内钾为102.87±6.97mEq/L,钠为9.61±0.85mEq/L,钾/钠比值为10.75±0.80。危重病人红细胞内钠明显升高,钾明显下降,钾/钠比值降低。腹部择期手术者术后红细胞内钾下降,钾/钠比值降低,但下降程度较小并持续一周左右。营养支持可使红细胞内钾/钠比值回升。红细胞内钾、钠浓度的改变与血清钾、钠浓度无显著相关;与血红蛋白含量、红细胞大小及血pH等亦无明显相关。

Investigation was conducted to see if changes in red cell sodium and potassium had any significance in surgical patients,especially in nutritional assessment.Red cells were washed and lysed by freeze-thawing,then Naand Kwere determined by flame photometry.In 20 normal persons,the mean values were K=102.87 mEq/L,Na=9.61 mEq/L and K/Naratio=10.75.In 10 critically ill patients,there were significant elevation of Na,decreased of Kand decrease in K/Naratio.In 20 patients undergoing elective abdominal operations,red cell Kdecreased and the K/Naratio remained low for 1 week.In 11 patients receiving amino acids,red cell K,Naand their ratio did not change significantly.Similarly,nutritional support of the critically ill increased the K/Naratio.This ratio increased with calorie-protein support.Changes in red cell K,Naand their ratio did not correlate with changes in serum Kand Na,MCV,MCH,MCHC and blood pH.Our studies suggest that operation or stress increases red cell Na,deereases Kwith a decrease in their ratio.These changes are part of the generalized cellular response to stress.Nutritional support can modify the effect of operation or stress on red cell Kand Na.