腹部手术后钾代谢的临床研究

Clinical research on potassium metabolism of abdominal operation.

目的探讨腹部术后是否需立即补钾，血钾与静脉补钾和钾排出的关系。方法测定４７例腹部手术前后血钾、钠、氯变化和尿、胃肠减压液体及引流液中电解质丢失量，分析酸碱平衡、肌酐清除率对钾代谢的影响。结果手术日和术后钾丢失平均７２９ｍｍｏｌ／ｄ，最多达２８９２ｍｍｏｌ／ｄ，尿钾浓度无明显改变，尿钾丢失主要为尿量增加所致。术后平均补钾４９８ｍｍｏｌ／ｄ，但血钾较术前明显降低（Ｐ＜００１），５例血钾低于３５ｍｍｏｌ，无一例出现高血钾。结论术后除应常规补钾外，应根据尿量随时调整钾的补充量。术后血钾向细胞内还是向细胞外转移受多因素影响，有待进一步研究。

Objective To investigate whether or not the immediate potassium infusion after abdominal surgery is necessary,and the relationship between serum potassium and potassium metabolism.Methods 47 abdominal surgery patients were investigated the electrolyte of serum,urine and drainage fluid was determind in the pre and post operation days.Results The urine potassium significantly increased in the operation day and the next,reaching 289 2mmol/d .Mainly because of the volume increase,the urine potassium concentration was relatively not changed.Serum potassium concentration decreased postoperatively in spite of the infusion potassium chloride 49 8mmol every postoperative day.Conclusion That the immediate supplement of potassium after operation is necessary,and the amount of potassium supply should be adjusted according to the urine volume.The potassium exchange between body cells and serum are influenced by multiple factors.