论文部分内容阅读
目的 分析血管紧张素转换酶抑制剂 (ACEI)与安体舒通在联合治疗心力衰竭 (心衰 )或高血压等疾病中发生严重高钾血症的危险因素和发生率。 方法 对ACEI和安体舒通联合治疗而致严重高钾血症 (血清钾 >6mmol/L)的 2 2例急诊患者进行观察和随访 (>1个月 ) ,并进行统计学分析。 结果 2 2例患者平均年龄 (72± 11)岁。患者入院后血清钾为 (7 3± 0 8)mmol/L ,血清肌酐为 (318 2± 15 0 3) μmol/L ;均显著高于入院前最后 1次测值 (4 5± 0 6 )mmol/L和 (15 9 1± 114 9)μmol/L。入院后动脉血 pH值为 7 3± 0 2、血浆碳酸氢盐为 (19± 6 )mmol/L。 19例有急性肾功能不全 ,其主要原因是脱水 (11例 )和心衰加重 (8例 )。安体舒通的每天平均剂量为 (4 8± 2 7)mg ,11例在治疗中同时服用可引起血钾升高的其他药物。 2 2例中 1例患者死亡 ,8例接受透析治疗 ,平均住院天数 (13± 5 )d。 结论 在肾功能不全、重度心衰、>70岁、糖尿病、脱水的老年患者中采用ACEI和安体舒通治疗时应监测血钾。安体舒通每天剂量不应超过 2 0mg。
Objective To analyze the risk factors and incidence of serious hyperkalemia associated with angiotensin converting enzyme inhibitor (ACEI) and spironolactone in the treatment of heart failure (heart failure) or hypertension. Methods Twenty-two emergency patients with severe hyperkalemia (serum potassium> 6mmol / L) were treated with ACEI and spironolactone for observation and follow-up (> 1 month), and statistical analysis was performed. Results The average age of 22 patients was 72 ± 11 years. Serum potassium was (73 ± 0 8) mmol / L and serum creatinine was (318 2 ± 15 0 3) μmol / L after admission to hospital, all of which were significantly higher than the last test before admission (45 ± 0 6) mmol / L and (15 9 1 ± 114 9) μmol / L. Arterial blood pH was 73 ± 0 2 and plasma bicarbonate was (19 ± 6) mmol / L after admission. 19 cases had acute renal insufficiency, the main reason is dehydration (11 cases) and heart failure (8 cases). The average daily dose of spironolactone was (48 ± 27) mg, while 11 other patients taking concurrent treatment with other drugs that caused elevated serum potassium levels were used. One out of 2 2 patients died and 8 received dialysis, with an average length of stay of 13 ± 5 days. CONCLUSIONS Potassium levels should be monitored in ACEI and spironolactone therapy in elderly patients with renal insufficiency, severe heart failure,> 70 years of age, diabetes, and dehydration. Spironolactone daily dose should not exceed 20mg.