基础医学与临床 ›› 2022, Vol. 42 ›› Issue (8): 1272-1273.doi: 10.16352/j.issn.1001-6325.2022.08.1272

• 疑难病例 • 上一篇    下一篇

一例罕见的术中高钾血症

马璐璐, 黄宇光*   

  1. 中国医学科学院 北京协和医学院 北京协和医院 麻醉科,北京 100730
  • 收稿日期:2022-02-24 修回日期:2022-05-26 出版日期:2022-08-05 发布日期:2022-08-01
  • 通讯作者: *garypumch@163.com

An unusual case of intraoperative hyperkalemia

MA Lu-lu, HUANG Yu-guang*   

  1. Department of Anesthesiology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
  • Received:2022-02-24 Revised:2022-05-26 Online:2022-08-05 Published:2022-08-01
  • Contact: *garypumch@163.com

摘要: 目的 探讨罕见高钾血症的病因,以提高临床医生对于此类疾病的认识。方法 收集一例因静脉系统闭塞、透析形成自循环、透析不充分所致的术中高钾血症患者的临床资料,并结合相关文献进行探讨,对本例患者的临床表现、病因和治疗进行总结。结果 高钾血症是维持性血液透析患者常见的并发症,严重者可以危急患者的生命。由于心电图对于血钾升高并不敏感,全麻患者术中高钾血症其表现不特异,给临床诊治带来困难。本例患者术中通过给予钙剂、促进钾离子向细胞内转移、纠正酸中毒、持续床旁血滤(CRRT)等治疗方法,逐步过渡到腹膜透析,病情稳定,顺利出院。结论 维持性透析、尤其是血管资源耗竭的患者,透析不充分是临床医生需要警惕的问题。对于此类患者尽早考虑腹膜透析,以保证患者的安全。

关键词: 高钾血症, 维持性透析, 血管通路

Abstract: Objective To report a rare case of intraoperative hyperkalemia and share our experience in the diagnosis and treatment with colleagues. Methods We reported 1 case of intraoperative hyperkalemia caused by central venous occlusion, auto-circulation of dialysis circuit and incomplete dialysis, the manifestation and treatment were summarized. Results Hyperkalemia is common in patients dependent on hemodialysis, and is a life-threatening complication. Electrocardiogram was not sensitive to hyperkalemia and the manifestations of intraoperative hyperkalemia are atypical, making the diagnosis difficult. After intravenous administrator of calcium and insulin,correction of acidosis and the application of continuous renal replacement therapy (CRRT), the patient started peritoneal dialysis gradually. Conclusions For patients who are dependent on hemodialysis and complicated with the failure of vascular access, incomplete dialysis is possible and peritoneal dialysis should be considered.

Key words: hyperkalemia, maintenance dialysis, vascular access

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