CAPD患者入院时低钾血症的发生率及其临床意义

The incidence of hypokalemia associated with CAPD patients on admission and its clinical significance

目的 了解门诊腹膜透析 (CAPD)患者入院时低钾血症的发生率及其与临床特点的关系。方法 采用电极法测定 1997～ 2 0 0 3年 1月间我院 4 1例门诊 CAPD患者入院时的血钾浓度 ,并结合临床及实验室资料进行分析。结果 CAPD患者入院时的血钾浓度为 3.6 5± 0 .82 mmol/ L,其中 2 3例患者血钾正常 (3.5～ 5 .5 mm ol/ L) ,17例患者为低钾血症 (<3.5 m mol/ L ) ,1例患者血钾增高 (>5 .5 mmol/ L )。 CAPD患者的血钾浓度与血清白蛋白(r=0 .5 2 ,P<0 .0 5 )、尿素氮 (r=0 .6 8,P<0 .0 1)和肌酐 (r=0 .5 0 ,P<0 .0 5 )呈正相关。低钾血症组患者的血钾浓度明显低于非低钾血症组 (2 .94± 0 .4 3m mol/ L vs4 .15± 0 .6 4 mm ol/ L,P<0 .0 1) ;CAPD患者低钾血症的发生与入院前蛋白质摄入不足 (P<0 .0 1)、尿量较多 (P<0 .0 1)、高腹透出超量 (P<0 .0 5 )关系密切。结论 门诊 CAPD患者入院时低钾血症的发生率较高 ;低钾血症的发生与入院前患者蛋白质摄入不足、钾离子丢失过多关系密切 ;低钾血症可以作为 CAPD患者营养不良的指标之一 ;及时发现与纠正低钾血症有助于提高 CAPD患者的生活质量与长期存活率。

Objective\ To investigate the incidence of hypokalemia and its relationship with clinical features in continuous ambulatory peritoneal dialysis(CAPD)patients on admission.Methods\ During the study period for 6yrs(1997～2003),the serum potassium(K) concentration of 41 admission CAPD patients were measured.Results\ The initial serum K concentration was 3 65±0 82 mmol/L and range from 2 1 to 6 0 mmol/L.The distribution was observed with normalkalemia(K +,3 5～5 5 mmol/L) in 23 cases,hypokalemia(K +<3 5 mmol/L) in 17 cases,and hyperkalemia(K +>5 5 mmol/L)in 1 case In all admissions,serum K concentration was significantly related to serum albumin(r=0 52, P <0 05),BUN(r=0 68, P <0 01)and creatinine(r=0 50, P <0 05) Also,the significant differences were found between hypokalemic and non hypokalemic patients in serum K concentration(2 94±0 43 mmol/L vs 4 15±0 64 mmol/L, P <0 01),urine volume(607 65±448 66 ml/d vs 250 42±313 44 ml/d, P <0 01),ultrafiltration volume(1509 41±607 26 ml/d vs 1225 00±314 39 ml/d, P <0 05)and poor protein intake before admission(13/17 vs 7/24, P <0 01) Conclusions\ There is a high incidence of hypokalemia in CAPD patients on admission,and its causes may contribute to poor dietary K intake and continued peritoneal K loss.Hypokalemia may serves as one of the markers of malnutrition in CAPD patients.Hypokalemia should be aware and prompt managements,so as to improve the quality of life and achieve long term survival in patients with CAPD.