重症急性胰腺炎早期血钾变化的临床分析

Clinical studies on severe acute pancreatitis patients in early stage associated with serum potassium

目的：探讨重症急性胰腺炎（SAP）患者早期血钾变化的发生机制和临床特点，对预后的影响及治疗措施。方法2002年9月1日至2012年5月31日收治的SAP 331例，分成轻度低钾血症组（血钾2.5～3.5 mmol/L）74例和重度低钾血症组（＜2.5 mmol/L）5例，血钾正常组（3.5～5.5 mmol/L）233例，高钾血症组（＞5.5 mmol/L）19例。分析比较各组SAP患者的相关并发症、相关临床参数、病死率和感染率。结果在 SAP 病程早期重度低钾血症组急性呼吸窘迫综合征（ARDS）发生率与血钾正常组相比无明显差异（P＞0.05）。重度低钾血症组胰性脑病的发生率与其他三组相比差异显著（P＜0.01）。高钾血症组肾功能衰竭、ARDS、心力衰竭及消化道出血的发生率明显高于轻度低钾血症组（P＜0.01）。高钾血症组的脉搏、呼吸、LDH、血糖、甘油三酯、血钙、HCT、Ranson 评分、APACHEⅡ评分、CT 评分均明显异于其他三组患者（P＜0.01）。高钾血症组与其他三组比较死亡率明显增高（P＜0.01），轻度低钾血症组与重度低钾血症组比较差异明显（P＜0.05），血钾正常组与轻度低钾血症组的死亡率相比较差异无明显统计学意义（P＞0.05）。说明患者如出现高钾血症死亡风险明显高于其他血钾异常组，血钾太低死亡风险亦增加。重度低钾血症组患者感染率与其他三组患者相比差异有明显统计学意义（P＜0.05）。结论高钾血症组出现肾脏、肺、心、消化道器官衰竭的概率高，而重度低钾血症组胰性脑病的发生率高。高钾血症组的SAP患者病情严重度高，死亡率高，但感染率不高于其他组患者。血钾降低死亡风险亦增加。

Objective To investigate the mechanism and clinical characteristics of severe acute pancreatitis （SAP） associated with potassium anomaly in the early stage and its influence on the prognosis of SAP and its therapeutic management and preventive.Methods331 cases diagnosed as SAP were accepted in our hospital from September 1, 2002 to May 31, 2012, and they were divided into 4 groups according to the level of plasma potassium： mild hypokalemia （2.5-3.5 mmol/L） group 74 cases, severe hypokalemia（〈2.5 mmol/L） group 5cases, normal serum potassium（3.5-5.5 mmol/L）group 233 cases and hyperkalemia（〉5.5 mmol/L）group 19 cases. The related complications and related clinical parameters in the early stage and the rate of mortality and infection were evaluated respectively.Results The incidence rates of ARDS in the early stage of SAP severe hypokalemia group has no statistical significance（P〉0.05） compared with mild hypokalemia group. The severe hypokalemia group had a higher incidence rate than other groups（P〈0.01） in the complication of pancreatic encephalopathy. The occurrence rate of kidney failure, ARDS and hemorrhage of digestive tract in hyperkalemia group were higher than those in the mild hypokalemia one（P〈0.01）. The frequencies of pulse, breath, LDH, blood glucose, triglyceride, blood calcium, HCT, the score of Ranson, APACHEⅡ and CT in the hyperkalemia group has markedly significance compared with the other three group （P〈0.01）. The mortality rate of hyperkalemia group were higher than other group （P〈0.01）. The differences of mortality between mild hypokalemia and severe hypokalemia group had statistical significance （P〈0.05）. But the death rate between the normal serum potassium group and mild hypokalemia group had no statistical significance（P〉0.05）. The hyperkalemia group has no significant difference of infection rate with other group（P〈0.01）.ConclusionHyperkalemia had a higher rate of occurrence of organ failure of kidney, lung, heart and gastrointestinal tract. But the severe hypokalemia group had a higher rate of pancreatic encephalopathy. The SAP patients with hyperkalemia had a higher severity and mortality. But its infection rate were not higher than other groups. The lower serum potassium, the higher death rate.