心脏移植术后高钾血症的危险因素及预测分析

Risk factors and predictive analysis of hyperkalemia after heart transplantation

目的分析心脏移植受者术后发生高钾血症的预后、危险因素及其预测指标。方法回顾性分析158例受者的临床资料,根据受者术后随访1年内的血钾水平分为正常血钾组(83例)、高钾血症组(43例)及重度高钾血症组(32例)。总结心脏移植术后高钾血症的发生情况及预后,分析心脏移植术后高钾血症的危险因素及预测指标。结果心脏移植术后1年高钾血症发生率为47.5%(75/158),重度高钾血症发生率20.3%(32/158)。重度高钾血症组的病死率为16%(5/32),高于正常血钾组的8%(7/83)和高钾血症组的7%(3/43)。术前半年血清肌酐(Scr)平均值、术前末次总胆红素、术后血液透析时间、术后1 d Scr及术后1 d脑钠肽前体是心脏移植术后发生高钾血症的独立危险因素(均为P<0.05)。术前半年Scr平均值、术后血液透析时间和术后1 d Scr、术后7 d Scr可预测术后重度高钾血症。结论心脏移植术后重度高钾血症的结局欠佳,心脏移植术后发生高钾血症的独立危险因素包括术前半年Scr平均值、术前末次总胆红素、术后血液透析时间、术后1 d Scr及术后1 d脑钠肽前体,围手术期Scr及术后血液透析时间可预测心脏移植术后1年内重度高钾血症。

Objective To analyze clinical prognosis,risk factors and predictive indexes of hyperkalemia in recipients after heart transplantation.Methods Clinical data of 158 recipients were retrospectively analyzed.According to the serum potassium levels within postoperative 1-year follow-up,all recipients were divided into the normal serum potassium level group(n=83),hyperkalemia group(n=43)and severe hyperkalemia group(n=32).The incidence and prognosis of hyperkalemia after heart transplantation were summarized.The risk factors and predictive indexes of hyperkalemia after heart transplantation were identified.Results The incidence of hyperkalemia and severe hyperkalemia within postoperative 1 year was 47.5%(75/158)and 20.3%(32/158),respectively.In the severe hyperkalemia group,the fatality was 16%(5/32),higher than 8%(7/83)in the normal serum potassium level group and 7%(3/43)in the hyperkalemia group.The mean serum creatinine(Scr)within 6 months before heart transplantation,the final total bilirubin level before heart transplantation,postoperative hemodialysis time,the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d were the independent risk factors for hyperkalemia following heart transplantation(all P<0.05).The mean Scr level within 6 months before heart transplantation,postoperative hemodialysis time,and Scr levels at postoperative 1 and 7 d could be used to predict postoperative severe hyperkalemia.Conclusions The recipients with severe hyperkalemia after heart transplantation obtain poor prognosis.The mean Scr level within 6 months before heart transplantation,the final total bilirubin level before heart transplantation,postoperative hemodialysis time,and the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d are the independent risk factors for hyperkalemia after heart transplantation.Perioperative Scr level and postoperative hemodialysis time may be used to predict the incidence of severe hyperkalemia within 1 year after heart transplantation.