小剂量普萘洛尔联合静脉补钾治疗甲亢伴周期性麻痹患者的疗效观察

Effect of low-dose propranolol combined with intravenous potassium supplement for treatment of patients with thyrotoxicosis-associated with periodic paralysis

目的观察小剂量普萘洛尔联合静脉补钾在甲亢伴周期性麻痹(TPP)患者补钾治疗中的效果。方法采用前瞻性单中心随机对照研究方法,选择2017年1月至2018年12月河北医科大学第二医院急诊科收治的TPP患者作为研究对象,按随机数字表法将患者分为对照组和研究组。最终50例患者完成临床试验及数据收集。其中对照组26例,研究组24例。对照组给予静脉补钾;研究组给予1mg/kg普萘洛尔口服联合静脉补钾。两组补钾速度均为10 mmol/h,补钾浓度均为200 mmol/L。比较两组患者的一般临床资料、肌力恢复至可行走时的血钾水平和补钾总量、肌力恢复至可行走所需时间以及补钾过程中反跳性高血钾和反常性低血钾的发生情况。结果两组患者的性别、年龄、体质量指数(BMI)、心率、血压、入院时实验室指标等一般临床资料比较差异均无统计学意义。与对照组比较,研究组患者肌力恢复至可行走所需时间明显缩短(h:5.34±2.15比7.17±3.80),补钾总量明显减少(mmol:54.58±15.60比68.08土23.84),反跳性高血钾发生率[25.00%(6/24)比57.69%(15/26)]及血钾异常总发生率[29.17%(7/24)比73.08%(19/26)]均明显降低,差异均有统计学意义(均P<0.05)。结论小剂量普萘洛尔联合静脉补钾治疗可显著缩短TPP患者肌力恢复时间。减少补钾量,降低反跳性高血钾发生率,提高TPP患者补钾治疗的安全性。

Objective To observe the efficacy of low-dose propranolol combined with intravenous potassium supplement in the treatment of patients with thyrotoxirosis-assoriated with periorlic paralysis(TPP).Methods A prospective,single renter,randomized controlled study was ronrluotefl,and the TPP patients admitted to the emergenry department of the Sec ond Hospital of Hebei Medical University from Januan 2017 to Dec ember 2018 were selerterl as the study ohjer ts.Accorcling to random number table methofl.the patients were rlivicled into control group and study gioup.Finally,50 patients compleled the clinical trial and data rolleding.inrhuling 26 patients in the pantrol group and 24 patients in the study group.The control group was given intravenous potassium supplement and study group was orally given propranolol(1 mg/kg)combined with intravenous potassium supplemenl.The intravenous drip of potassium supplement rate of the two groups were 10 mmol/h,and the potassium concentration was 200 mmol/L.The general clinical data,the level of blood potassium and total amount of potassium supplement from the initiation of potassium chlorifle therapy to the reroveiy of sufficienl muscle strength to ambulate,the rerover time of suffirient muscie strength to ambulate,the inrirleru es of rebound hyperkalemia and abnormal hypokalemia in the process of potassium supplement were compared between the two groups of patients.Results There were no statistical signifiranl differences in general clinical data such as gender,age,borly mass index(BMI),heart rate,blood pressure and lahoraton,indexes on aflmission between the two groups of patienls.Compared to the control group,the reroveiy time of sufficient muscle strength to ambulate was significantly shortened(hours:5.34±2.15 vs.7.17±3.80),the total amount of potassium supplement was obviously less(mmol:54.58±15.60 vs.68.08±23.84),the inriflenre of rehound hyperkalemia[25.009%(6/24)vs.57.69%(15/26)]and the total inridence of abnormal hloorl potassium[29.17%(7/24)vs.73.08%(19/26)]were both significantly lower in the study group,the differences being statistically signifirant(all P<0.05).Conclusion Low-dose propranolol romhined with inlravenous potassium supplement can signifirantly reduce the rerovertime of muscle strength,ihe dosage of potassium supplemenl and the incidence of rebound hyperkalemia,and improve the safety of potassium supplement therapy in patients with TPP.