螺内酯及其他相关因素对慢性充血性心力衰竭患者血清钾离子浓度的影响

The impact of spironolactone and other complications on serum potassium concentration of patients with chronic congestive heart failure

目的观察慢性充血性心力衰竭患者应用螺内酯后高钾血症的发生率,并分析血钾水平的影响因素。方法对我院收治的126例LVEF<35%的慢性充血性心力衰竭患者,首次并持续服用螺内酯20mg/d、氢氯噻嗪25mg/d1个月以上。观察高钾血症的发生率,将各因素对血钾的影响进行Logistic回归分析。结果126例中有3例发生严重高钾血症。年龄、2型糖尿病、肌酐水平、服药前血钾水平、应用福辛普利钠(商品名蒙诺)剂量对血钾水平的影响有显著意义。结论螺内酯20mg/d与氢氯噻嗪25mg/d合用,在慢性心力衰竭患者中对血清钾离子水平影响不大,年龄、2型糖尿病、肌酐水平、服药前血钾水平、并用福辛普利钠剂量为应用螺内酯20mg/d加氢氯噻嗪25mg/d后血钾水平增高的独立预测因素。

Objective To observe the rate of hyperkalemia after using spironolactone and analyse the complications that may impact the serum potassium in chronic congestive heart failure when spironolactone were prescribed. Methods 126 patients with heart failure who had a left ventricular ejection fraction 〈35% and initiated a prescription of spironolactone 20mg daily and hydrochlorothiazide 25mg daily in our hospital and already used for more than lmonths were selected. The rate of hyperkalemia was calculated and the complications that may impact the serum potassium after using spironolactone were analysed using logistic regression. Results Three of 126 patients （2.4%） developed hyperkalemia. Age, DM, creatinine, serum potassium before taking spironolactone, ACEI being used were the complications that significantly impacted the serum potassium concenrtion. Conclusions Spironolactone 20mg daily combined with hydrochlorothiazide 25mg daily had little impact on serum potassium in chronic congestive heart failure patients. Age, DM, creatinine, serum potassium before taking spironolactone, the dosage of ACEI are independent indicators of hyperkalemia.