哌拉西林钠他唑巴坦钠致低钾血症的发生情况及危险因素分析

Analysis of the occurrence and risk factors of hypokalemia caused by piperacillin sodium and tazobactam sodium

目的探讨哌拉西林钠他唑巴坦钠(TZP)相关低钾血症的发生情况及其危险因素。方法通过医院电子病历系统收集2022年1月至2023年1月在临沂市中心医院接受TZP治疗的成年住院患者临床资料,包括患者人口学信息、感染部位、主要基础疾病、实验室检查、TZP信息及并用药物等,从中筛选出TZP相关低钾血症患者。对TZP相关低钾血症的发生情况进行描述性统计分析。根据是否发生TZP相关低钾血症将患者分为低钾血症组和非低钾血症组,比较2组患者的临床特征,将差异有统计学意义的临床特征纳入多因素logistic回归,分析TZP相关低钾血症发生的影响因素。结果共有363例患者纳入分析,其中86例(23.7%)低钾血症被判定为与TZP相关,涉及男性46例(53.5%),女性40例(46.5%);年龄76(68,83)岁。76例患者低钾血症的严重程度(88.4%)为轻度,10例(11.6%)为中度,无重度低钾血症发生。低钾血症组与非低钾血症组患者临床特征比较的结果显示,患者性别,年龄,体重指数,感染部位为肺部感染、腹腔/消化道感染、尿路感染者占比,基础疾病存在冠状动脉粥样硬化性心脏病和无主要基础疾病者占比,基线血红蛋白、血清总蛋白、血清白蛋白、血钙和血镁,TZP治疗期间并用保钾利尿药和其他利尿药者占比的差异均有统计学意义(均P<0.05)。将上述变量纳入多因素logistic回归,结果显示仅基线血镁水平为TZP相关低钾血症的独立影响因素,基线血镁水平越低TZP相关低钾血症发生的风险越高(比值比=0.105,95%置信区间:0.012~0.956,P=0.045)。结论低钾血症为TZP较常见的不良反应,临床应给予关注。基线血镁水平较低可能与TZP治疗期间低钾血症发生的风险增高有关。

Objective To explore the occurrence and risk factors of piperacillin sodium and tazobactam sodium(TZP)-related hypokalemia.Methods The clinical data of adult inpatients treated with TZP in Linyi Central Hospital from January 2022 to January 2023 were collected through the hospital′s electronic medical record system,including patient demographic information,infection sites,major underlying diseases,laboratory tests,TZP use information and concomitant drugs,and patients with TZP-related hypokalemia were screened.The occurrence of TZP-related hypokalemia was analyzed by descriptive statistics.According to whether or not having TZP-related hypokalemia,the patients were divided into hypokalemia group and non-hypokalemia group,and the clinical characteristics were compared.The clinical characteristics with statistically significant differences between 2 groups were included in the multivariate logistic regression,and the risk factors of TZP-related hypokalemia were analyzed.Results A total of 363 patients were included in the analysis,of which 86(23.7%)were with hypokalemia and were judged to be associated with TZP,46(53.5%)were male and 40(46.5%)were female;the age was 76(68,83)years.Of the 86 patients,76(88.4%)had mild hypokalemia,10(11.6%)had moderate hypokalemia,and none had severe hypokalemia.Through clinical characteristic comparison between the hypokalemia group and the non-hypokalemia group,statistically significant differences were found in patient gender,age,body mass index,the proportion of proportion of patients with coronary atherosclerotic heart disease and without major underlying diseases,baseline hemoglobin,serum total protein,serum albumin,blood calcium,blood magnesium,and the proportion of patients using potassium preserving diuretics and other diuretics during TZP treatment(all P<0.05).The above variables were included in the multivariate logistic regression,and the results showed that only the baseline level of blood magnesium was an independent influencing factor of TZP-related hypokalemia,and the lower the level,the higher the risk(odds ratio=0.105,95%confidence interval:0.012-0.956,P=0.045).Conclusions Hypokalemia is a common adverse reaction of TZP,which should be paid attention to in clinic.The lower level of blood magnesium at baseline may be related to the increased risk of hypokalemia during TZP treatment.