超低出生体重儿非少尿性高钾血症的临床特征

Clinical features of non-oliguric hyperkalemia in extremely low birth weight infants

目的探讨超低出生体重儿(extremely low birth weight infant,ELBWI)发生非少尿性高钾血症(non-oliguric hyperkalemia,NOHK)的相关危险因素、电解质特点及预后。方法 2012年3月至2015年3月,在中国医科大学附属盛京医院第二新生儿病房住院的患儿中,纳入体重﹤1 000 g的ELBWI共91例为研究对象。根据血清钾水平及尿量分为NOHK组(22例)、少尿性高钾血症组(8例)、正常对照组(61例)。监测生后24、48及72小时的血清钾、钙水平及出入液量。比较3组患儿的基本信息、合并症、生后72小时内出入液量及电解质浓度、治疗措施、孕母情况及患儿预后。采用方差分析和χ~2检验进行统计分析。结果 NOHK组阴道分娩比例高于对照组[63.6%(14/22)与21.3%(13/61),P﹤0.05)。NOHK组和少尿性高钾血症组的多胎比例高于对照组[59.1%(13/22)、87.5%(7/8)与27.9%(17/61),P﹤0.05];NOHK组、少尿性高钾血症组与对照组的胎龄分别为(27.6±1.6)、(27.7±1.0)与(28.7±1.7)周,5分钟Apgar评分分别为(7.8±1.3)、(7.5±1.3)与(8.4±0.9)分,NOHK组和少尿性高钾血症组均低于对照组(P值均﹤0.05)。少尿性高钾血症组与对照组中挤压伤的比例分别为37.5%(3/8)与4.9%(3/61),输血率分别为87.5%(7/8)与33.9%(7/61),少尿性高钾血症组均高于对照组(P值均﹤0.05)。3组患儿发生窒息、酸中毒、宫内感染性肺炎、动脉导管未闭的比例,差异无统计学意义(P﹥0.05)。3组患儿发生脑损伤、NEC、早产儿视网膜病变、肺部疾病、死亡的比例比较,差异无统计学意义(P值均﹤0.05)。结论 NOHK与早产儿发育不成熟相关;NOHK与少尿性高钾血症的血钾水平、预后方面无差异,P值均﹤0.05。ELBWI患儿无论是否存在少尿,均应监测血钾水平,及时处理高钾血症。

Objective To investigate the related risk factors, electrolyte characteristics and prognosis of non-oliguric hyperkalemia（NOHK） in extremely low birth weight infants（ELBWI）. Methods From March 2012 to March 2015, 91 cases of ELBWI whose birth weight ﹤1 000 g, admitted by the Second Department of Neonatology of Shengjing Hospital of China Medical University were included. They were divided into NOHK group（22 cases）, oliguric hyperkalemia group（8 cases） and control group（61 cases） according to the serum potassium levels and urine volume. The level of serum potassium, calcium and intakeoutput liquid volume were monitored in 24, 48 and 72 h after birth. Basic information, complications, intakeoutput liquid volume and electrolyte concentration within 72 h after birth, therapeutic measures, conditions of pregnant women and prognosis of three groups were compared. Statistical analysis was performed by variance analysis and χ~2 test. Results The proportion of vaginal delivery of NOHK group was higher than that of control group[63.6%（14/22） vs 21.3%（13/61）, P﹤0.05]. The proportion of polyembryony of NOHK group and oliguric hyperkalemia group were higher than that of control group [59.1%（13/22） and 87.5%（7/8） vs 27.9%（17/61）, P﹤0.05]. Gestational age of NOHK group, oliguric hyperkalemia group and control group were（27.6±1.6）,（ 27.7±1.0） and（28.7±1.7） weeks respectively; 5-minute-Apgar score were（7.8±1.3）,（7.5±1.3） and（8.4±0.9） respectively; the above two indicators of NOHK group and oliguric hyperkalemia group were lower than those of control group（both P﹤0.05）. The proportion of crush injury of oliguric hyperkalemia group and control group were 37.5%（3/8） and 4.9%（3/61）; rate of blood transfusion were 87.5%（7/8） and 33.9%（7/61）; the above two indicators of oliguric hyperkalemia group were higher than those of control group（both P﹤0.05）. There were no statistically significant differences for the proportion of occurrence of asphyxia, acidosis, intrauterine infectious pneumonia and patent ductus arteriosus of three groups（P﹥0.05）. And there were also no statistically significant differences for the rate of occurrence of brain injury, necrotizing enterocolitis（NEC）, retinopathy of prematurity（ROP）, pulmonary disease and death of three groups（P﹥0.05）. Conclusions NOHK is related to developmental immaturity of premature.There are no difference of the level of serum potassium and prognosis between NOHK and oliguric hyperkalemia patients. But the level of serum potassium of ELBWI should be monitored and hyperkalemia should be treated regardless of oliguria.