妇科手术后血钾监测及低钾血症影响因素分析

Influencing factors on hypokalemia post gynecological surgery and the monitoring of serum potassium

目的探讨妇科手术后监测血钾的倾向性及低钾血症的影响因素。方法回顾性分析2012年1月至12月在北京大学第一医院妇科行择期手术的325例住院患者术后低钾血症的临床资料。比较术后监测血钾组与未监测血钾组及低钾血症组与血钾正常组恶性肿瘤、清洁洗肠、开腹手术、是否48 h后进普通饮食（普食）等临床特点。结果术后监测血钾组与未监测血钾组恶性肿瘤、清洁洗肠、开腹手术、48 h后进普食与术后监测血钾相关（r分别为41.262、30.656、28.564、25.270,p均=0.000）;多因素分析显示,手术方式、肠道准备类型是妇科手术后是否监测血钾的独立影响因素（OR=2.608,95%CI：1.405~4.839;OR=2.620,95%CI：1.535~4.471）。术后低钾血症组与血钾正常组术后48 h内进普食者与术后低钾血症相关（r=5.525,p=0.030）。结论对恶性肿瘤、清洁洗肠、开腹手术、术后48 h后开始进普食患者,术后应加强监测患者术后血钾情况,对低钾血症者提早采取补钾措施,以保证患者安全。

Objective To explore the influencing factors on hypokalemia post gynecological surgery and to study the serum potassium monitoring method, Methods A retrospective study with 325 patients hospitalized at Peking University First Hospital （PUFH） from January 2012 to December 2012 was performed. Patients were divided into two groups according to whether testing serum potassium value post gynecological surgery. The clinical characteristics were compared between two groups. The clinical characteristics was compared between the groups of patients with hypokalemia and normal serum potassium value. Results The present study showed that we tended to monitor the serum potassium value in patients with malignant tumors, cleansing enema, laparotomy, and whether having general diet 48 hours post-operatively. Multivariate analysis showed that the operation method of laparotomy vs laparoscopy and the bowel preparation types were independent influencing factors for the tendency of serum potassium monitoring. The other analysis showed that having general diet within 48 hours post-operatively associated with hypokalemia. Conclusion The gynecological malignancy, cleansing enema, laparotomy, whether having general diet within 48 hours post operation were associated with the tendency of post-operative serum potassium monitoring. The monitoring of post-operative serum potassium should be strengthened and proper prophylactic actions should be taken to avoid post-operative hypokalemia.