心脏术后患者合用托拉塞米与柠檬酸钾颗粒或氯化钾缓释片对血钾的影响

Effects of torasemide combined with potassium citrate granules or potassium chloride sustained-release tablets on serum potassium after cardiac surgery

目的:探讨心脏术后患者合用托拉塞米与柠檬酸钾颗粒或氯化钾缓释片对患者血钾水平的影响。方法:收集2016年9月至2017年2月首都医科大学附属北京安贞医院心外科接受心脏手术的142例患者临床资料,并进行回顾性分析。按口服补钾制剂的种类,分为氯化钾组96例,柠檬酸钾组46例,分析比较治疗5 d后血钾的变化情况及低血钾的发生率,并比较不同剂量的补钾制剂对血钾变化的影响。结果:氯化钾组补钾量显著低于柠檬酸钾组(P<0.001),5 d后氯化钾组血钾呈下降趋势,柠檬酸钾组血钾呈上升趋势,且血钾变化差异具有统计学意义[(-0.069±0.482)vs(0.15±0.425)mmol·L^(-1),P=0.008],氯化钾组低钾血症的发生率显著高于柠檬酸钾组(6.25%vs 0%,P<0.001)。服用不同剂量的柠檬酸钾的患者血钾变化值无显著性差异(P>0.05);服用不同剂量氯化钾的患者血钾变化值有显著性差异(P=0.047)。结论:心脏术后肾功能正常的患者,服用柠檬酸钾的血钾达标率较氯化钾高,低血钾症发生风险较低。口服托拉塞米利尿的患者,补充大剂量柠檬酸钾对血钾的影响较小,随着补充氯化钾剂量降低,血钾水平随之降低,使用氯化钾时需要补充足够的钾制剂。

Objective： To investigate the effects of torasemide combined with potassium citrate granules or potassium chloride sustained-release tablets on serum potassium level. Methods： A total of 142 patients underwent cardiac surgery from September 2016 to February 2017 in Beijing Anzhen Hospital were enrolled in this study. The patients were divided into potassium chloride group（96 cases）, potassium citrate group（46 cases）. The level of 5 day serum potassium and the incidence of hypokalemia were analyzed. The effect of different dosage of potassium formulation on the changes in serum potassium were compared. Results： The dosage of potassium chloride group was significantly lower than that in potassium citrate group（P〈0.001）. Serum potassium of potassium chloride group decreased but was increased in potassium citrate group [（-0.069±0.482） vs（0.15±0.425） mmol·L^（-1）, P = 0.008]. The incidence of hypokalemia in potassium chloride group was significantly higher than that in potassium citrate group（6.25% vs 0%, P〈0.001）. There was no significant difference in the level of serum potassium in subgroups of different dosages within potassium citrate group（P〈0.05）. There was a significant difference in the changes of serum potassium among different dosage groups of potassium chloride（P = 0.047）. Conclusion： The risk of hypokalemia in potassium citrate is lower than potassium chloride. Patients taking torasemide has little effects on potassium level when using high dosages of potassium citrate. Blood potassium levels decreases when the dosage of potassium chloride decreases. Adequate dose of potassium chloride should be applied.