高血压脑出血后血钾紊乱的危险因素分析

Risk factors for hypokalemia and hyperkalemia after hypertensive cerebral hemorrhage

目的总结高血压脑出血后血钾紊乱的特点和规律,旨在为临床诊治提供参考。方法回顾性分析菏泽市立医院神经外科2016-01-2017-12收治的503例高血压脑出血患者的临床资料,应用Logistic多因素回归分析方法评价血钾紊乱的危险因素,探讨其发生的规律。结果高血压脑出血后血钾紊乱好发于发病后1周内。低钾血症、高钾血症发生率分别为48.9%、2.5%。性别、袢利尿药、手术、GCS为低钾血症的危险因素(P<0.05)。年龄、袢利尿药、GCS为高钾血症的危险因素(P<0.05)。女性、应用袢利尿药、经过手术、病情越重则发生低钾血症的风险越大。年龄越大、病情越重则发生高钾血症的风险越高,应用袢利尿药是高钾血症的保护因素。结论高血压脑出血常并发血钾紊乱,病情重、应用袢利尿药增加低钾血症的发生率已经形成共识,女性、手术是低钾血症的危险因素需要被临床工作者重视。年龄增加、病情重的患者应警惕发生高钾血症。在发病后早期易出现血钾紊乱,据此规律应早发现并及时纠正。

Objective To investigate and summarize the characteristics and principles of hypokalemia and hyperkalemia after hypertensive cerebral hemorrhage,in order to provide reference for clinical workers in the diagnosis and treatment of the disease.Methods The clinical data of 503 patients hospitalized in the Department of Neurosurgery of Heze Municipal Hospital from January 2016 to December 2017 were collected,who were definitely diagnosed as hypertensive cerebral hemorrhage,and these clinical data were analyzed retrospectively.The risk factors for hypokalemia and hyperkalemia were evaluated by Logistic nonconditional multivariate regression analysis.The regularity and characteristics of its occurrence are discussed.Results Hyperkalemia and hypokalemia are likely to occur within 1 week after hypertensive cerebral hemorrhage.The incidence of hypokalemia and hyperkalemia were 48.9% and 2.5%.Sex,loop diuretics,surgery,and GCS(Glasgow coma scale) were independent risk factors for hypokalemia(P<0.05).Age,loop diuretics,and GCS were independent risk factors for hyperkalemia(P<0.05).Females,loop diuretics,surgery,and severe cases are associated with increased risk of hypokalemia.The higher age and severity of the disease,the higher risk of hyperkalemia.The application of loop diuretics is a protective factor of hyperkalemia.Conclusion Hypokalemia and hyperkalemia often occur after hypertensive intracerebral hemorrhage,and the serious condition and application of loop diuretics can increase the incidence of hypokalemia,which has been a consensus.Women and surgery are risk factors of hypokalemia,which should be paid more attention to by clinical workers.The risk factors for hyperkalemia are age and illness.Hyperkalemia and hypokalemia are easy to occur in the early stage of hypertensive cerebral hemorrhage.Accordingly,its should be discover early and correct in time.