胡仁德 但勇 宋华强

[摘要] 目的 尽快纠正严重低钾血症，探讨对重度低钾血症患者使用高浓度快速静脉补钾的安全性及有效性。 方法 将104例重度低钾血症（血钾浓度＜2.5 mmol/L）的患者随机均分为治疗组和对照组。治疗组通过外周大静脉予高浓度（0.6%）氯化钾溶液、快速度（2.5～3.0 g/h）输注补钾。对照组是传统补钾，按1.0～1.5 g/h速度持续静脉输注0.3%氯化钾液。记录两组血钾上升至3.5 mmol/L时所需时间及心律失常等情况。 结果 血钾恢复正常（3.5 mmol/L）时间治疗组明显短于对照组，差异有统计学意义（t =2.391，P ＜ 0.05）。且治疗组无一例死亡，无明显副作用。 结论 在严密监测下高浓度快速外周静脉补钾是治疗重度低钾血症行之有效安全的方法，值得临床推广应用。

[关键词] 低钾血症；周围血管；高浓度氯化钾；心电监护

[中图分类号] R591.1[文獻标识码] A[文章编号] 1674-4721（2012）07（c）-0067-02

Observation of rescue of 52 cases of severe hypokalemia patients with peripheral vascular supplement of high concentration kalium

HU Rende DAN Yong SONG Huaqiang

The First People's Hospital of Changde City in Hunan Province, Changde 415000, China

[Abstract] Objective To correct severe hypokalemia as soon as possible, and discuss the safety and effectiveness of using high concentration and speediness intravenous supplement of kalium in the treatment of serious low potassium blood disease patients. Methods One hundred and four patients with severe hypokalemia (concentration of serum kalium was < 2.5 mmol/L) were divided into the treatment group and the control group randomly. The treatment group was treated with high concentration (0.6%) potassium chloride solution and injected rapidly (2.5-3.0 g/h), though peripheral large veins. The control group was given traditional supplement of kalium, continuous intravenous 0.3% potassium chloride fluid with the speed of 1.0-1.5 g/h. The time of serum kalium rose to 3.5 mmol/L of the two group and the arrhythmia condition were recorded. Results The time of serum kalium recovered to normal (3.5 mmol/L) of the treatment group was shorter than that of the control group, the difference was statistically significant (t =2.391, P < 0.05). And in the treatment group, no cases was dead, and there was no obvious side effects. Conclusion High concentration and speediness intravenous supplement of kalium under close monitor is a effective and safe method in the treatment of severe hypokalemia, which is worthy of clinical application

[Key words] Hypokalemia; Peripheral vascular; High concentrations potassium chloride; Electrocardiogram monitoring

由于钾对心肌、横纹肌等电兴奋组织应激性的重要影响。当血钾降到2.5 mmol／L以下时就容易产生诸如室性期前收缩、室性心动过速、心室颤动、软瘫和呼吸困难等严重症状，如不及时提高血钾水平就会危及生命[1]。而传统的静脉补钾，对浓度、速度有严格限制，氯化钾溶液浓度不宜超过0.3%，剂量不宜超过1.5 g/h，第1日总量不宜超过9 g[2]。这样势必导致血钾回升慢，同时常伴随大量液体的输入，对危重患者和补液量有严格限制的心血管患者等很不利。为探讨高浓度快速补钾的安全性和有效性，本院急诊科在2006年10月～2011年10月采用外周静脉高浓度快速补钾抢救重度低血钾，尽快使血钾浓度升高至正常，取得了很好的疗效。……