继发性低钾血症致室性心律失常的心电图特点及防治策略

ECG characteristics,preventive and therapeutic strategy of ventricular arrhythmias induced by secondary hypokalemia

目的:探讨继发性低钾血症致室性心律失常的相关临床表现、心电图特点及治疗策略。方法:回顾性分析我院2013年1月至2015年11月确诊为继发性低钾血症致室性心律失常的184例患者的临床资料,分析其心电图特点及临床表现,比较治疗前后血钾浓度及室性心律失常情况。根据血钾浓度,患者被分为轻度低钾血症组(91例,3.01~3.5mmol/L)、中度低钾血症组(78例,2.51~3.00mmol/L)和重度低钾血症组(15例,<2.5mmol/L),比较各组间心电图改变情况。结果:患者主要的临床表现为心悸、胸闷、乏力、低血压、气促等,严重的表现为昏迷、肠麻痹、晕厥等。心电图表现以室性期前收缩多见,为75例(40.8%),其次为频发房性期前收缩69例(37.5%)。与轻度低钾血症组比较,中度、重度低钾血症组心电图改变阳性的比例(50.5%比79.5%、100%)显著升高(P均=0.001),而中度与重度组间无显著差异(P=0.120)。与治疗前比较,本组患者治疗后血钾浓度[(2.5±1.1)mmol/L比(4.4±1.7)mmol/L]显著升高,室性早搏(86.96%比25.00%)和持续性室速(8.70%比0)比例显著降低,P均=0.001。结论:继发性低钾血症致室性心律失常的患者心电图异常比例随血钾的降低而升高,对此类患者应当及时行心电图及血钾浓度检查,以便得到及时的治疗。

Objective：To explore related clinical manifestations,ECG characteristics and therapeutic strategy of ventricular arrhythmias induced by secondary hypokalemia.Methods：Clinical data of 184 patients,who were diagnosed as ventricular arrhythmias induced by secondary hypokalemia in our hospital from Jan 2013 to Nov 2015,were retrospectively analyzed.ECG characteristics and clinical manifestations were analyzed,blood potassium concentration and incidence of ventricular arrhythmia were compared between before and after treatment.According to blood potassium concentration,patients were divided into mild hypokalemia group（n=91,3.01-3.5 mmol/L,mild group）,medium hypokalemia group（n=78,2.51-3.00 mmol/L,medium group）and severe hypokalemia group（n=15,〈2.5 mmol/L,severe group）.ECG condition was compared among these groups.Results：Main clinical manifestations included palpitations,chest tightness,fatigue,hypotension and short of breath etc.,and severe patients can present as coma,intestinal paralysis and syncope etc.Among ECG manifestations,premature ventricular systole was the most frequent[75（40.8%）],and the second was frequent premature atrial systole[69（37.5%）].Compared with mild group,there were significant rise in percentage of positive ECG changes（50.5% vs.79.5%,100%）in medium group and severe group（P=0.001 both）,but there was no significant difference between medium and severe group,P=0.120.Compared with before treatment,after treatment,there was significant rise in blood potassium concentration[（2.5±1.1）mmol/L vs.（4.4±1.7）mmol/L],and significant reductions in percentages of ventricular premature contraction（86.96% vs.25.00%）and persistent ventricular tachycardia（8.70% vs.0）in these patients,P=0.001 all.Conclusion：Along with blood potassium level reduces,percentage of patients with ventricular arrhythmias induced by secondary hypokalemia and abnormal ECG rises.Timely ECG and blood potassium examinations should be performed in these patients for timely treatment.