环硅酸锆钠散对慢性肾脏病严重高钾血症患者短期降钾效果的临床观察

doi:10.3760/cma.j.issn.1007-1245.2022.06.030

摘要/Abstract

摘要： 目的　观察环硅酸锆钠散对慢性肾脏病严重高钾血症患者的短期降钾效果。方法　回顾性分析2020年11月至2021年5月于粤北人民医院就诊的慢性肾脏病合并严重高钾血症拒绝急诊血液透析并服用环硅酸锆钠散的11例患者临床资料，分析短期治疗效果及药物安全性。用药前后符合正态分布的计量资料比较采用配对t检验；降钾幅度与用药前静脉钾水平的相关性采用Pearson相关性分析。结果　11例患者中，男8例、女3例；年龄（75.5±12.5）岁；合并高血压10例（90.91%），糖尿病3例（27.27%），冠心病1例（9.09%），心衰1例（9.09%）；估算肾小球滤过率（eGFR）<15 ml·min^-1·（1.73 m²）^-1患者7例（63.64%），≥15 ml·min^-1·（1.73 m²）^-1患者4例（36.36%）。11例患者用药前静脉血钾（7.02±0.54）mmol/L，用药后第2天晨间复查血钾（4.62±0.76）mmol/L，第1天给药降钾幅度为（2.40±0.43）mmol/L，用药前后比较差异有统计学意义（P<0.001）。根据初始静脉血钾水平分为两组，≥7.00 mmol/L组4例，第1天降幅（3.26±0.70）mmol/L；6.50～7.00 mmol/L组7例，第1天降幅（1.91±0.64）mmol/L；两组之间第1天血钾降幅差异有统计学意义（P=0.024）。第1天静脉血钾降幅与用药前静脉钾水平呈正相关（r=0.318，P=0.047）。治疗中出现1例低钾血症，2例呕吐，未发现其他不良反应。结论　环硅酸锆钠散在24 h内有效降低慢性肾脏病伴严重高钾血症患者的血钾水平，安全性高。

关键词: 高钾血症, 慢性肾脏病, 环硅酸锆钠散

Abstract: Objective　To observe the short-term potassium lowering effect of sodium zirconium cyclosilicate powder in patients with severe hyperkalemia of chronic kidney disease. Methods　The clinical data of 11 patients with chronic kidney disease complicated with severe hyperkalemia who refused emergency hemodialysis and took sodium zirconium cyclosilicate powder in Yuebei People's Hospital from November 2020 to May 2021 were retrospectively analyzed, and the short-term treatment effect and drug safety were analyzed. Paired t test was used to compare the measurement data with normal distribution before and after medication. The correlation between potassium reduction range and intravenous potassium level before medication was analyzed by Pearson correlation analysis. Results　Among the 11 patients, 8 cases were male and 3 cases were female, aged (75.5±12.5) years; there were 10 cases (90.91%) with hypertension, 3 cases (27.27%) with diabetes, 1 case (9.09%) with coronary heart disease, and 1 case (9.09%) with heart failure; the estimated glomerular filtration rate (eGFR) was <15 ml·min^-1· (1.73 m²)^-1 in 7 cases (63.64%), and ≥15 ml·min^-1· (1.73 m²)-1 in 4 cases (36.36%). The intravenous potassium level of 11 patients was (7.02±0.54) mmol/L before medication, and (4.62±0.76) mmol/L in morning reexamination on the second day after medication, and the potassium reduction range on the first day was (2.40±0.43) mmol/L, with a statistically significant difference before and after medication (P<0.001). According to the initial intravenous potassium level, 4 patients in the ≥7.00 mmol/L group were decreased by (3.26±0.70) mmol/L on the first day, 7 patients in the 6.50-7.00 mmol/L group were decreased by (1.91±0.64) mmol/L on the first day; there was a statistically significant difference in the potassium reduction range between the two groups on the first day (P=0.024). The potassium reduction range on the first day was positively correlated with the level of intravenous potassium before medication (r=0.318, P=0.047). Hypokalemia occurred in 1 case and vomiting in 2 cases, and no other adverse reactions were found. Conclusion　Sodium zirconium cyclosilicate powder can effectively reduce the blood potassium level in patients with chronic kidney disease and severe hyperkalemia within 24 hours, with high safety.

Key words: Hyperkalemia, Chronic kidney disease, Sodium zirconium cyclosilicate powder

李儒刚, 黄洁平, 旷双红, 梁泽智, 钟靖华. 环硅酸锆钠散对慢性肾脏病严重高钾血症患者短期降钾效果的临床观察[J]. 国际医药卫生导报, 2022, 28(6): 854-858.

Li Rugang, Huang Jieping, Kuang Shuanghong, Liang Zezhi, Zhong Jinghua. Clinical observation on the effect of sodium zirconium cyclosilicate powder on short-term potassium lowering in patients with severe hyperkalemia of chronic kidney disease[J]. International Medicine and Health Guidance News, 2022, 28(6): 854-858.

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