儿茶酚胺诱致的低血钾及其在急性心肌梗塞时的临床意义

Catecholamine-induced Hypokaiemia and Its Implications in Acute Myocardial Infarction

本实验中8只兔输注肾上腺素(AD)导致明显低血钾;6只兔静注普萘洛尔后再输注AD则未出现低血钾。26例急性心肌梗塞(AMI)病人入院时血浆儿茶酚胺(CA)显著升高,其中73％存在相对性低血钾,其红细胞内钠/钾比值亦明显降低且与血浆AD呈负相关。多因素分析表明AMI时的高CA血症和低血钾均与室性心律失常有关。本文结果提示AD通过作用于β受体可激活细胞膜上的Na^+-K^+-ATP酶,是导致AMI时低血钾的原因。

Adrenaline (AD) infusion to 8 rabbits led to remarkable dose-dependent hypokalemia. In 6 rabbits with i.v. propranolol beforehand, no hypokale-mia occurred after AD infusion. Plasma catecholamines in 26 patients with AMI were greatly elevated at admission. A significant lowering of intraerythrocytic rate of Na/K was observed, and relative hypokalemia was present in 73% of patients. These findings were inversely correlated with plasma AD. According to the multivariate analysis, both high level of plasma AD and hypokalemia were responsible for ventricular arrhythmia in early AMI. Our experimental results indicate that the high level of plasma AD in AMI can cause hypokalemia via β-adrenocep-tor through stimulating Na-K-ATPase on cell membrane.