林明增 范佳妮 陈霄峰 陈文芬

腹膜透析和血液透析对尿毒症患者血钾的影响

林明增 范佳妮 陈霄峰 陈文芬

目的 探讨血液透析与腹膜透析对尿毒症患者血钾的影响。方法对97例血液透析及45例腹膜透析均治疗3个月以上的患者进行血钾、血钠、血氯测定和比较，并调查当月患者的尿量及住院情况。结果腹膜透析组的低钾、低钠、低氯血症发生率分别为20.0%、15.6%、37.8%，而血液透析组分别为2.1%、4.1%、16.5%，两组差异有统计学意义（P＜0.05）。血液透析组的高钾血症发生率为28.9%，而腹膜透析组为11.1%，两组差异有统计学意义（P＜0.05）。血液透析组患者的血钾、血氯分别为（5.076±1.093）、（99.660±3.889）mmol/L，腹膜透析组分别为（4.435±0.99）、（96.910±3.646）mmol/L，两组差异均有统计学意义（均P＜0.05）。尿量＞500ml者腹膜透析组占55.6%，血液透析组占6.2%，两组差异有统计学意义（P＜0.05）。两组患者住院率的差异无统计学意义（P＞0.05）。结论腹膜透析组低钾血症发生率高，血液透析组的高钾血症发生率高，需要对不同透析方式的患者饮食状况进行相应的指导，不能忽视患者在使用一些药物时对血钾异常可能产生的影响。

血液透析 腹膜透析 血钾

【 Abstract】 ObjectiveTo investigate the effects of peritoneal dialysis and hemodialysis on blood potassium concentration in patients with uremia.MethodsThe levels of serum potassium,sodium and chloride were measured in 45 uremic patients undergoing peritoneal dialysis and 97 patients undergoing hemodialysis for more than three months.In addition,the urine output and hospitalization of patients were also documented.ResultsThe incidence rate of hypokalemia,hyponatremia and low chlorine in peritoneal dialysis group was 20.0%,15.6%and 37.8%;and in peritoneal dialysis group was 2.1%,4.1%,16.5%respectively(P＜0.05).The incidence of hyperkalaemia in hemodialysis and periotoneal dialysis groups was 28.9%and 11.1%,respectively(P＜0.05).Serum potassium and chloride levels in hemodialysis patients were 5.076±1.093mmol/L and 99.660± 3.889mmol/L,those in peritoneal dialysis group were 4.435±0.99mmol/L and 96.910±3.646mmol/L,respectively(P＜0.05).The patients with urine output＞500ml in peritoneal dialysis and hemodialysis groups accounted for 55.6%and 6.2%,respectively (P＜0.05).These was no difference in hospitalization between two groups.ConclusionThe higher incidence of low blood potassium,sodium and chlorine concentrations occurs in patients with peritoneal dialysis，while higher incidence of blood hyperkalemia occurs in patients with hemodialysis.The results indicate that diet guidance is needed for uremic patients undergoing different types of dialysis and caution should be taken for some drugs which may lead to potassium anomaly.

随着人口老龄化，透析患者将急剧增加。血液透析和腹膜透析各有优缺点，但两种透析方法均可引起患者的血电解质紊乱。其中血液透析患者高钾血症的发生率较高，低钾血症的发生率低[1]，而对于血钠、血氯的异常因对人体的危害相对轻，临床报道较少。而血钾异常可出现肌肉无力、严重引起致死性心律失常[2]，需要临床引起高度重视。腹膜透析由于透析方式的不同，血钾等电解质的变化会与血液透析不同。……