华西医学

华西医学

微量泵补钾与传统补钾在连续性肾脏替代治疗中的应用效果比较

查看全文

目的 探讨微量泵补钾在连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)患者治疗中的可行性及应用效果。 方法 2018 年 3 月—5 月纳入行 CRRT 的危重症患者,并随机分为微量泵组和传统补钾组。治疗过程中,微量泵组使用微量泵入 10% 氯化钾,传统补钾组采用传统的加 10% 氯化钾入置换液的方式补钾,通过测定两组患者 CRRT 治疗前(0 h)和治疗后 2、8、12、24 h 外周血钾水平、血钾控制达标率、不良事件发生率、平均更换液袋次数、平均停泵时间、达成剂量和实际补钾量比较两组加钾方式的应用效果。 结果 共纳入 60 例患者,两组各 30 例。两组患者 CRRT 治疗前(0 h)和治疗后 2、8、12、24 h 外周血钾水平、血钾控制达标率和达成剂量差异均无统计学意义(P>0.05);不良事件发生率、平均更换液袋次数、平均停泵时间和实际补钾量差异均有统计学意义(P<0.05)。 结论 微量泵补钾在 CRRT 患者治疗中的应用具备可行性及安全性,且较传统补钾方式更具优势,可在临床进一步推广应用。

Objective To explore the feasibility and effect of infusion pump potassium supplementation in continuous renal replacement therapy (CRRT). Methods Patients who underwent CRRT were randomly divided into infusion pump group and traditional way group between March and May 2018. In infusion pump group, 10% potassium chloride was supplemented with infusion pump. In traditional way group, 10% potassium chloride was supplemented in the traditional way, which meant adding potassium in the replacement solution. The peripheral blood potassium level, the potassium well-controlled rate, the incidence of adverse events, the average frequency of replacement liquid bags change, the average pump stopping time, and the delivery dose and potassium supplement dose between the two groups were compared. Results A total of 60 patients were randomly divided into two groups, with 30 cases in each group. The infusion pump group was treated with an average of 6.90 mL/h potassium supplement dose by infusion pump, and in traditional way group, potassium was added to the replacement solution by an average of 9.29 mL/h; there were significant differences between the two groups (P<0.05). When compared with traditional way group, there was no significant differences (P>0.05) in the peripheral blood potassium level and the potassium well-controlled rate of the patients at 0, 2, 8, 12 and 24 hours after CRRT (P>0.05). As for the adverse events rate, average frequency of replacement liquid bags change, average pump stopping time, and potassium supplement dose, there were significant differences between the two groups (P<0.05). Conclusions The application of infusion pump to supply potassium in CRRT is feasible and safe, and is superior to the traditional potassium supplement method. It could be further applied in clinical practice.

关键词: 连续性肾脏替代治疗; 微量泵; 氯化钾

Key words: Continuous renal replacement therapy; Infusion pump; Potassium chloride

引用本文: 陈志文, 唐晓娟, 王蓓蓓, 张胜, 魏甜甜, 代明金. 微量泵补钾与传统补钾在连续性肾脏替代治疗中的应用效果比较. 华西医学, 2018, 33(7): 856-859. doi: 10.7507/1002-0179.201807008 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 付平. 连续性肾脏替代治疗. 北京: 人民卫生出版社, 2016: 3.
2. 陈香美. 血液净化标准操作规程 2010 版. 北京: 人民军医出版社, 2010: 47, 68-69.
3. 蔡吉, 赵慧华, 张育红, 等. 微量泵输注高浓度氯化钾临床应用的护理进展. 护理学杂志, 2012, 27(22): 93-96.
4. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med, 2009, 361(17): 1627-1638.
5. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
6. 黄家驷, 吴阶平. 外科学 (上册). 北京: 人民卫生出版社, 1982: 150-151.
7. 郑惠鹏, 史伟. 微泵静脉注射氯化钾溶液抢救严重低钾血症 1 例. 广东医学, 2005, 26(1): 119.
8. 王海龙, 张亚会, 唐莉杰. 高浓度氯化钾微量泵注射在重度低钾血症中的应用. 中国医药指南, 2011, 9(13): 122-123.
9. 刘辉, 杨晓华, 王苏华. 微量泵高浓度泵钾在心脏瓣膜置换术后早期的应用. 西部医学, 2010, 22(12): 2348-2349.
10. 陈雪芳. 10 例应用微量泵外周静脉高浓度补钾的临床观察与护理. 全科护理, 2009, 7(4): 895-896.
11. 陆再英, 钟南山. 内科学. 7 版. 北京: 人民卫生出版社, 2008: 689-691.
12. Bundgaard H, Kjeldsen K. Potassium depletion increases potassium clearance capacity in skeletal muscles in vivo during acute repletion. Am J Physiol Cell Physiol, 2002, 283(4): C1163-C1170.
13. Uijtendaal EV, Zwart-van Rijkom JE, van Solinge WW, et al. Frequency of laboratory measurement and hyperkalaemia in hospitalised patients using serum potassium concentration increasing drugs. Eur J Clin Pharmacol, 2011, 67(9): 933-940.
14. 王艳, 曹积慧. 锁骨下静脉微量泵高浓度补钾的疗效观察. 中国医药指南, 2016, 34(14): 152-153.
15. 邓岩. 静脉注射高浓度氯化钾抢救严重低血钾一例. 中外医疗, 2010(32): 83.
16. 张利娟, 黄金美, 费忠英. 微量泵注射高浓度氯化钾治疗严重低钾血症患者的护理进展. 当代护士: 下旬刊, 2014, 10(3): 7-9.