大量输血对严重创伤患者血钾的影响

Influence of massive blood transfusion on serum potassium in patients with severe trauma

目的：探讨大量输血对严重创伤患者血钾的影响及高钾血症发生的危险因素。方法：选择2011-03-2015-05廊坊市第四人民医院收治的严重创伤患者203例,排除挤压伤患者。将进行大量输血（外伤后24h内红细胞输注〉10U且保存时间〈20d）的107例患者设为大量输血组,对照组为同一时期未输血的严重创伤患者96例。入院时进行创伤严重程度评估并记录性别、年龄、创伤方式等一般资料。对2组患者术前、术后及术后12h血钾,术前、术后12h动脉血pH,术前肌酐,术后12h血糖进行水平测定。对高钾血症发生的影响因素进行多因素回归分析。结果：12组患者在年龄、性别及创伤方式等方面差异无统计学意义（P〉0.05）,在创伤严重程度方面差异有统计学意义（P〈0.05）;2大量输血组术后高钾血症的发生率高于对照组（P〈0.05）;3多因素回归分析显示,大量输血与术后高钾血症无明显相关性（95%CI：0.040~5.286;OR=0.62;P〉0.05）,而术前高血钾和术后pH值降低是高钾血症的主要影响因素。结论：大量输血治疗并未直接导致高血钾的发生,但仍有一定的高钾血症发生率,因此在输血治疗过程中仍需动态监测血钾的变化,以降低高血钾所带来的并发症。

Objective：To explore the influence of massive blood transfusion on serum potassium in patients with severe trauma.Method：A total of 203 cases of severe trauma patients with massive blood transfusion were choosed as the research group in our hospital from March 2011 to May 2015.One hundred and seven patients received a large number of blood transfusion were as massive blood transfusion group,and 96 severe trauma patients without blood transfusion as the control group.The general information such as gender,age,trauma manner and traumatic severity were recorded on admission.Preoperative potassium,postoperative potassium,postoperative12 hpotassium,preoperative arterial blood pH,postoperative 12 harterial blood pH,preoperative creatinine and postoperative 12 hblood glucose were determined in two groups,and hyperkalemia related influencing factors were analyzed.Result：1 There were no statistical difference among age,gender,and trauma manner in two groups（P〈0.05）,injury severity was statistically different（P〈0.05）.2The incidence of postoperative hyperkalemia in massive blood transfusion group was higher than that in control group（P〈0.05）.3 Massive blood transfusion and postoperative hyperkalemia had no significant correlations（95%CI：0.040 to 5.286;OR=0.62;P〈0.05）,and high preoperative potassium and postoperative lower pH were the main risk factors of hyperkalemia.Conclusion：Massive blood transfusion cannot lead to high potassium,but there is still a certain incidence of hyperkalemia.Therefore dynamic monitoring of the change of potassium and renal function in patients may be needed in the process of transfusion,to reduce the complications of high potassium.