低钾血症对急性心肌梗死患者预后的影响

Effects of hypokalemia on prognosis of patients with acute myocardial infarction

目的探讨急性心肌梗死（AMI）患者低钾血症的发生情况及其对预后的影响.方法对929例ST段抬高的AMI患者于入院时抽血测定血钾、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、肌钙蛋白Ⅰ（cTnⅠ），根据血钾水平分为低血钾组（血钾〈3．5mmol／L）和正常血钾组（血钾3．5～5．5mmol／L），同时观察住院期间严重不良事件（室性心动过速、心室颤动和猝死）的发生情况．结果低钾血症的发生率为13．7％，下壁＋后壁AMI的发生率最低（10．4％），明显低于下后壁＋右心室、前间壁和广泛前壁心肌梗死；发病至抽血时间≤3h的低钾血症发生率为17．3％，明显高于发病时间〉3h者；低血钾组的CK、CK-MB和cTnⅠ峰值明显高于正常血钾组；低血钾组总的严重不良事件发生率（23．8％）明显高于正常血钾组（15.8％）、结论低钾血症与AMI患者的梗死时间、部位和面积相关，并严重影响患者的预后。

Objective To investigate the incidence of hypokalemia and its effects on prognosis in patients with acute myocardial infarction（AMI）.Methods Levels of serum potassium, CK, CK-MB and troponin（cTnⅠ） were examined on admission in 929 individuals with ST elevated acute myocardial infarction. The patients were divided into hypokalemia group （serum potassium≤3.5 mmol/L） and normal potassium group （serum potassium 〉 3.5 mmol/L）. Major adverse cardiac events （ death） were recorded during hospital stay. Results ventricular tachycardia, ventricular fibrillation and sudden Total incidence of hypokalemia was 13.7%, and incidence of hypokalemia in inferior wall and posterior wall （ 10.4% ） AMI was lower than that in inferior ＋ posterior wall ＋ right ventricle and anterior wall AMI. The rate of hypokalemia during the time from onset to taking blood ≤3 hours was higher than that during the time 〉 3 hours. Peak levels of CK,CK-MB and cTnⅠ in hypokalemia group were higher than those in normal potassium group. Total incidence of major adverse cardiac events in hypokalemia group （23.8%） was higher than that in normal potassium group（ 15.8% ）. Conclusion Hypokalemia is associated with time, location and area of myocardial infarction, and has severe effect on the prognosis of AMI.