急性心肌梗死患者早期血钾动态变化及其临床意义

Serum potassium changes in patients with early acute myocardial infarction and its clinical significance

目的 探讨急性心肌梗死（AMI）患者早期血钾水平的动态变化,分析血钾水平与心肌梗死类型、并发症之间的联系.方法 入选2012年3月至2014年9月期间就诊于保定市第一中心医院的286例AMI患者（发病时间＜ 12 h）,依据AMI患者发病时间,将患者分为＜3h、3～6h、～12 h三组;依据AMI患者入院时血钾水平,将患者分为＜ 3.50 mmol/L、≥3.50 mmol/L两组;依据AMI患者心电图ST段的变化,将患者分为ST段抬高型急性心肌梗死（STEMI,n=128）和非ST段抬高型急性心肌梗死（NSTEMI,n=158）两组.记录AMI患者的梗死类型及住院期间并发症发生率.结果 286例AMI患者中低血钾总发生率为23.8％.发病时间＜3h组低钾血症构成比为52.9％ （36/68）;3～6 h组为25.0％（17/68）,～12h组为22.1％ （15/68）,以发病时间＜3h组低钾血症构成比最高,差异有统计学意义（P＜0.01）.STEMI患者低钾血症构成比为55.9％（38/68）,NSTEMI患者构成比为44.1％（30/68）,STEMI患者在发病早期低钾血症的构成比高于NSTEMI患者（P＜0.05）;低钾血症患者组恶性室性心律失常（MVA）、心力衰竭（心衰）的发生率分别为22.1％与32.4％;血钾正常组MVA、心衰的发生率分别为6.0％与18.3％;低钾血症组高于血钾正常组（P＜0.01,P＜0.05）.结论 AMI早期患者低钾血症可能高发于发病3h内的某个时段,发病3h后低钾血症发生率呈下降趋势;STEMI患者发病早期低钾血症发生率较高,且存在低钾血症患者的MVA、心衰发生率较高.AMI早期应及时预防性补钾,同时制定更加积极的治疗方案,以预防并发症发生.

Objective To evaluate the dynamic changes of serum potassium in patients with early acute myocardial infarc- tion（ AMI）, and find the association among serum potassium level and the types and complications of AMI. Methods A total of 286 early AMI patients（ time from symptom onset to inhospital being less than 12 h） treated in Baoding First Cen- ter Hospital during March 2012 to September 2014 were enrolled in present study. According to the time interval from symp- tom onset to inhospital, AMI patients were assigned to less 3 h group,3 -6 h group, and 6 -12 h group（ from more than 6 h to 12 h）. The peripheral venous blood was detected immediately when the AMI patients got into hospital. The patients were divided into hypokalemia group （ serum potassium less than 3.5 mmol/L） and normal serum potassium group （ serum po- tassium more than or equal to 3.5 mmoL/L） according to the serum potassium levels. There were two types of ST segement elevation AMI（STEMI） and non ST segement elevation AMI （NSTEMI） based on the changes of electrocardiogram（ECG） Complication rates and types of AMI during hospitalization were recorded and analyzed in each group. Results The inci- dence of hypokalemia was 23.8 % in 286 AMI patients The constituent ratios of hypokalemia were 52.9% （36/68） in 〈 3 h group, 25.0% （17/68） in 3 -6 h group and 22.1% （15/68） in 6 - 12 h group, respectively. There were statistical differences in constituent ratios of different groups （ all P 〈 0.01 ） , in which the constituent ratio of hypokalemia in 〈 3 h group was the highest one. The constituent ratio of hypokalemia of early STEMI patients was higher than that of early NSTEMI patients [ （ 55.9 % （ 38/68 ） vs 44.1% （ 30/68 ）, P 〈 0.05 ]. The incidences of malignant ventricular arrhythmia （MVA） and heart failure （HF） were both significantly higher in hypokalemia group （22.1% , 32.4% ） than those in nor- mal potassium group （6.0% , 18.3 % ） （ P 〈 0. 01, P 〈 0.05 ）. Conclusions The peak incidence of hypokalemia in AMI patients maybe in a certain period of time within 3 hours of symptoms onset, then show downward trend over time. The inci- dence of hypokalemia is higher in STEMI patients, and once AMI patients are concurrent with hypokalemia, MVA and HF may occur more frequently. Appropriate control of serum potassium levels can help to reduce the occurrence of complica- tions, and can improve the prognosis of patients.