大剂量使用糖皮质激素时预防补钾现状及建议

Current Situation and Clinical Suggestion of High-dose Glucocorticoid Supplementation

目的分析大剂量使用糖皮质激素治疗患者血钾水平变化,为临床预防性补钾提供建议。方法选取2019年1月至2021年5月在郑州市第二人民医院进行大剂量甲泼尼龙琥珀酸钠冲击治疗的患者447例,通过卡方检验分析预防补钾组和非预防补钾组血钾水平下降的发生率是否有差异,通过SPSS线性回归分析初始血钾值为多少应预防补钾。结果447例患者中371例(83.00%)患者给予补钾治疗、76例(17.00%)未给予补钾治疗;预防补钾组42例(11.32%)发生血钾值减低、非预防补钾组6例(7.89%)发生血钾值减低。大剂量使用激素前后两组血钾值减低的发生率差异无统计学意义(P>0.05),血钾的变化值与血钾的初始值存在的线性回归关系:Y=2.105-0.512X。结论血钾的降低与是否预防性补钾不相关。当初始血钾值大于4.11 mmol/L时,预防补钾反而导致血钾下降,不建议初始血钾值大于4.11 mmol/L的患者预防性补钾。

Objective To analyze the changes of blood potassium level in patients treated with high-dose glucocorticoid, and provide suggestions for clinical preventive potassium supplementation. Methods 447 patients who received high-dose methylprednisolone sodium succinate shock therapy at The Second People's Hospital of Zhengzhou from January 2019 to May 2021 were selected to analyze the association between the incidence of hypokalemia and the change of serum potassium level after potassium supplementation in the prevention and non prevention potassium supplementation groups by chi square test;cut point values for prevention of potassium supplementation were analyzed by SPSS linear regression. Results Potassium supplementation for prophylaxis was given to 371 (83.00%) of 447 patients and not given to 76 (17.00%) patients;hypokalemia occurred in 42 patients (11.32%) in the prophylactic potassium supplementation group and in 6 patients (7.89%) in the non prevention potassium supplementation group. There was no statistical difference in the incidence of blood potassium reduction between the two groups before and after high-dose hormone use. The linear regression between the change value of serum potassium and the presence of the initial value of serum potassium was as follows: Y=2.105-0.512X. Conclusion: The decrease of blood potassium is not related to whether preventive potassium supplementation is necessary. When the initial blood potassium value is greater than 4.11 mmol/L, preventive potassium supplementation will lead to a decrease in blood potassium. It is not recommended to take preventive potassium supplementation for patients with initial blood potassium value greater than 4.11 mmol/L.