红细胞输注期间高钾血症性心跳骤停：系列病例研究

背景与输血相关的高钾性心跳骤停是快速输注红细胞时发生的一项严重并发症。本文对快速输注红细胞过程中发生高钾血症及心跳骤停患者的临床情况和预后进行研究。方法本研究对1988年11月1日至2006年12月31日间，Mayo临床麻醉资料库记载的手术中发生输血相关性高钾血症及心跳骤停的所有患者进行了回顾性分析。结果我们确认共有16例因输血发生高钾性心跳骤停的患者，其中成年患者11例，儿童患者5例。多数患者接受如下3种手术：肿瘤手术、大血管手术及创伤手术。心跳骤停时血清钾离子平均浓度为7．2±1．4mEq／L（范围5．9-9．2mEq/L）。心跳骤停前红细胞输注量为1（2．7kg的新生儿）～54单位。心跳骤停时，几乎所有患者都存在酸中毒、高血糖症、低钙血症及体温过低。14例（87．5％）患者从中心静脉输注红细胞。11例成人患者中8例（72．7％）采用了市售高速输注泵，其他3例患者使用加压输血袋和快速注射泵输注红细胞。平均复苏时间为32分钟（2～127分钟），院内存活率为12．5％。结论输血相关的高钾血症性心跳骤停涉及多种发病机制，心输出量低下、酸中毒、高血糖症、低钙血症及低体温均可加重红细胞输注时的血钾升高。大出血输注大量库存红细胞时，应高度警惕高钾血症的可能，并做好预防措施。

BACKGROUND： Transfusion-associated hyperkalemic cardiac arrest is a serious complication of rapid red blood cell （RBC） administration. We examined the clinical scenarios and outcomes of patients who developed hyperkalemia and cardiac arrest during rapid RBC transfusion. METHODS： We retrospectively reviewed the Mayo Clinic Anesthesia Database between November 1, 1988, and December 31, 2006, for all patients who developed intraoperafive transfusion-associated hyperkalemic cardiac arrest. RESULTS： We identified 16 patients with transfusion-associated hyperkalemic cardiac arrest, 11 adult and 5 pediatric. The majority of patients underwent three types of surgery： cancer, major vascular, and trauma. The mean serum potassium concentration measured during cardiac arrest was 7.2 ± 1.4 mEq/L （ range, 5.9 - 9.2 mEq/L）. The number of RBC units administered before cardiac arrest ranged between 1 （in a 2.7 kg neonate） and 54. Nearly all patients were acidotic, hyperglycemic, hypocalcemic, and hypothermic at the time of arrest. Fourteen （87.5%） patients received RBC via central venous access. Commercial rapid infusion devices （pumps） were used in 8 of 11 （72.7%） of the adult patients, but RBC units were rapidly administered （pressure bags, syringe pumped） in all remaining patients. Mean resuscitation duration was 32 min （ range, 2 - 127 rain）. The inhospital survival rate was 12.5%. CONCLUSION： The pathogenesis of transfusion-associated hyperkalemic cardiac arrest is multifactorial and potassium increase from RBC administration is complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia. Large transfusion of banked RBCs and conditions associated with massive hemorrhage should raise awareness of the potential for hyperkalemia and trigger preventative measures.