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目的:探讨大量输血对严重创伤患者血钾的影响及高钾血症发生的危险因素。方法:选择2011-03-2015-05廊坊市第四人民医院收治的严重创伤患者203例,排除挤压伤患者。将进行大量输血(外伤后24h内红细胞输注>10U且保存时间<20d)的107例患者设为大量输血组,对照组为同一时期未输血的严重创伤患者96例。入院时进行创伤严重程度评估并记录性别、年龄、创伤方式等一般资料。对2组患者术前、术后及术后12h血钾,术前、术后12h动脉血pH,术前肌酐,术后12h血糖进行水平测定。对高钾血症发生的影响因素进行多因素回归分析。结果:12组患者在年龄、性别及创伤方式等方面差异无统计学意义(P>0.05),在创伤严重程度方面差异有统计学意义(P<0.05);2大量输血组术后高钾血症的发生率高于对照组(P<0.05);3多因素回归分析显示,大量输血与术后高钾血症无明显相关性(95%CI:0.040~5.286;OR=0.62;P>0.05),而术前高血钾和术后pH值降低是高钾血症的主要影响因素。结论:大量输血治疗并未直接导致高血钾的发生,但仍有一定的高钾血症发生率,因此在输血治疗过程中仍需动态监测血钾的变化,以降低高血钾所带来的并发症。
Objective: To investigate the effect of massive blood transfusion on serum potassium in patients with severe trauma and the risk factors of hyperkalemia. METHODS: Totally 203 severe traumatic patients admitted to the Fourth People’s Hospital of Langfang City from March 2011 to May 2015 were selected, and patients with crush injuries were excluded. A large number of blood transfusions were enrolled in 107 patients who underwent massive blood transfusion (red blood cell transfusion> 10U and preservation time <20d after trauma). The control group consisted of 96 patients with severe trauma who were not transfused during the same period. Assess the severity of trauma at admission and record general information such as gender, age, and trauma pattern. Preoperative, postoperative and postoperative 12h serum potassium, preoperative and postoperative 12h arterial blood pH, preoperative creatinine, postoperative 12h blood glucose levels were measured. The influencing factors of hyperkalemia were analyzed by multivariate regression analysis. Results: There was no significant difference in age, sex and trauma between the 12 groups (P> 0.05), and there was significant difference in the severity of trauma (P <0.05) (P <0.05) .3Multivariate regression analysis showed that there was no significant correlation between mass transfusion and postoperative hyperkalemia (95% CI: 0.040-5.286; OR = 0.62; P> 0.05) ), While preoperative hyperkalemia and postoperative pH value is the main influencing factor of hyperkalemia. Conclusion: A large number of blood transfusion therapy does not directly lead to the occurrence of hyperkalemia, but there is still a certain incidence of hyperkalemia, so blood transfusion in the process of monitoring the need for dynamic changes in serum potassium to reduce hyperkalemia brought Complications.