CRRT救治急性肾功能不全并高钾血症致心跳骤停1例

One case of CRRT Treated Cardiac Arrest Caused by Acute Renal Insufficiency and Hyperkalemia

1例50岁男性患者,因"头部及全身多处外伤后一小时余伴昏迷"入院。入院诊断为"特重型颅脑损伤并晚期脑疝",入院后急诊入手术室行"左L侧额颞顶叶去骨瓣减压+颅内血肿清除+左L额极内减压+气管切开+清创缝合术",术毕转入ICU监测及治疗。术后第6天,14:44血电解质示K+:8.62 mmol/L,目前尿量210 mL,予以利尿剂、钙剂、胰岛素等降钾处理,16:05患者突然出现心跳骤停,予以心肺复苏后心率恢复,急查血气分析示K+:8.41 mmol/L,肾功能示尿素:17.52 mmol/L、肌酐:476.4 μmol/L,紧急行床边CRRT,6小时后复查血气分析示血钾4.21 mmol/L,术后第8天结束床边CRRT,此后一周内未再见心跳骤停情况。

A50-year-old male patient was admitted to the hospital due to"multiple head and body trauma followed by coma for more than one hour".Upon admission,he was diagnosed as"extremely severe craniocerebral injury and advanced cerebral hernia".After admission,he was admitted to the operating room for emergency treatment for"left L side frontotemporal parietal lobe decompression+intracranial hematoma removal+left L frontopolar decompression+tracheotomy+debridement suture",and was transferred to ICU for monitoring and treatment after the surgery.On the6th day after the surgery,blood electrolyte showed K+:8.62mmol/L at14:44,and the current urine volume was210mL,which was treated with diuretics,calcium,insulin and other potassium lowering treatments.The patient suddenly had cardiac arrest at16:05,and the heart rate recovered after cardiopulmonary resuscitation.Urgent blood gas analysis showed K+:8.41mmol/L,kidney function showed urea:17.52mmol/L,creatinine:476.4μ/L,bedside CRRT was performed urgently.6hours later,blood gas analysis showed4.21mmol/L of potassium.Bedside CRRT was ended on the8th day after surgery,and cardiac arrest was not found within a week.