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心脏移植术后高钾血症的危险因素及预测分析

陈斯瑶, 吴敏, 黄劲松, 等. 心脏移植术后高钾血症的危险因素及预测分析[J]. 器官移植, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
引用本文: 陈斯瑶, 吴敏, 黄劲松, 等. 心脏移植术后高钾血症的危险因素及预测分析[J]. 器官移植, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
Chen Siyao, Wu Min, Huang Jinsong, et al. Risk factors and predictive analysis of hyperkalemia after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
Citation: Chen Siyao, Wu Min, Huang Jinsong, et al. Risk factors and predictive analysis of hyperkalemia after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014

心脏移植术后高钾血症的危险因素及预测分析

doi: 10.3969/j.issn.1674-7445.2023.01.014
基金项目: 

国家自然科学基金青年基金 82000081

广州市基础研究计划基础与应用基础研究项目 202201011721

详细信息
    作者简介:
    通讯作者:

    吴怡锦,博士,副主任医师,研究方向为心脏移植,Email:wuyijin@gdph.org.cn

  • 中图分类号: R617, R541

Risk factors and predictive analysis of hyperkalemia after heart transplantation

More Information
  • 摘要:   目的  分析心脏移植受者术后发生高钾血症的预后、危险因素及其预测指标。  方法  回顾性分析158例受者的临床资料,根据受者术后随访1年内的血钾水平分为正常血钾组(83例)、高钾血症组(43例)及重度高钾血症组(32例)。总结心脏移植术后高钾血症的发生情况及预后,分析心脏移植术后高钾血症的危险因素及预测指标。  结果  心脏移植术后1年高钾血症发生率为47.5%(75/158),重度高钾血症发生率20.3%(32/158)。重度高钾血症组的病死率为16%(5/32),高于正常血钾组的8%(7/83)和高钾血症组的7%(3/43)。术前半年血清肌酐(Scr)平均值、术前末次总胆红素、术后血液透析时间、术后1 d Scr及术后1 d脑钠肽前体是心脏移植术后发生高钾血症的独立危险因素(均为P < 0.05)。术前半年Scr平均值、术后血液透析时间和术后1 d Scr、术后7 d Scr可预测术后重度高钾血症。  结论  心脏移植术后重度高钾血症的结局欠佳,心脏移植术后发生高钾血症的独立危险因素包括术前半年Scr平均值、术前末次总胆红素、术后血液透析时间、术后1 d Scr及术后1 d脑钠肽前体,围手术期Scr及术后血液透析时间可预测心脏移植术后1年内重度高钾血症。

     

  • 图  1  心脏移植围手术期临床指标预测术后重度高钾血症的ROC曲线

    Figure  1.  ROC curves of perioperative clinical indicators for predicting severe hyperkalemia after heart transplantation

    表  1  心脏移植术后发生高钾血症危险因素的单因素分析

    Table  1.   Univariate analysis of risk factors for hyperkalemia after heart transplantation

    变量 分组 统计值 P
    正常血钾组(n=83) 高钾血症组(n=43) 重度高钾血症组(n=32)
    术前资料
      高血压[n(%)] 9(11) 6(14) 10(31)a, b 7.376 0.025
      糖尿病[n(%)] 13(16) 8(19) 9(28) 2.338 0.311
      慢性肾病[n(%)] 1(1) 2(5) 5(16)a, b 10.012 0.007
      术前半年Scr平均值(x±s,μmol/L) 89±23 100±20 131±48a, b 23.462 < 0.001
      术前末次Scr(x±s,μmol/L) 87±23 97±23 134±52a, b 26.156 < 0.001
      术前末次血钾(x±s,mmol/L) 4.0±0.4 4.2±0.5a 4.1±0.5 3.644 0.028
      术前末次总胆红素[M(P25, P75),μmol/L] 20(14, 28) 26(17, 39) a 23(15, 35) 6.292 0.038
      术前末次尿pH值(x±s) 5.8±0.7 5.8±0.6 5.8±0.6 0.139 0.870
      使用呼吸机[n(%)] 7(8) 4(9) 2(6) 0.236 0.889
      机械辅助循环[n(%)] 5(6) 2(5) 4(13) 5.110 0.276
    术中资料
      体外循环时间[M(P25, P75),min] 249(215, 287) 230(205, 267) 229(204, 270) 3.843 0.146
      阻断时间[M(P25, P75),min] 126(113, 140) 124(107, 139) 116(103, 142) 3.319 0.190
      冷缺血时间[M(P25, P75),min] 207(186, 240) 210(189, 233) 187(159, 231) 4.523 0.104
      出血量[M(P25, P75),mL] 300(300, 500) 400(300, 500) 300(225, 400) 2.152 0.341
      输冷沉淀量[M(P25, P75),U] 0(0, 0) 0(0, 10.0) 0(0, 9.9) 3.468 0.177
      术中尿量[M(P25, P75),mL] 500(300, 1 000) 600(350, 1 100) 500(350, 850) 0.941 0.625
    术后资料
      机械辅助循环[n(%)] 11.608 0.021
        无 65(78) 31(72) 15(47)a, b
        1种 13(16) 9(21) 11(34)
        2种 5(6) 3(7) 6(19)
      血液透析[n(%)] 22(27) 18(42) 28(88)a, b 35.082 < 0.001
      血液透析时间[M(P25, P75),h] 0(0, 0) 2.3(0, 11.0) 28.5 (3.3, 49.8)a, b 45.684 < 0.001
      术后当日血钾(x±s,mmol/L) 3.9±0.5 3.8±0.5 4.0±0.5 2.216 0.112
      术后1 d尿酸(x±s,μmol/L) 519±147 563±172 556±217 1.126 0.327
      术后1 d Scr[M(P25, P75),μmol/L] 135(103, 158) 163(123, 196) a 209(180, 270) b 34.517 < 0.001
      术后7 d Scr[M(P25, P75),μmol/L] 101(77, 156) 148(108, 229) 252(157, 410)a, b 35.160 < 0.001
      术后1 d脑钠肽前体[M(P25, P75),pg/mL] 2 406(982, 4 185) 3 321(1 031, 8 763) 4 734(1 774, 11 180)a 8.788 0.012
    注:与正常血钾组比较,aP < 0.05/3; 与高钾血症组比较,bP < 0.05/3。
    下载: 导出CSV

    表  2  心脏移植术后发生高钾血症危险因素的多因素分析

    Table  2.   Multivariate analysis of risk factors for hyperkalemia after heart transplantation

    变量 回归系数 标准误 Wald χ2 OR①值 95% CI P
    术前半年Scr平均值 0.032 0.006 31.091 1.033 1.021 ~ 1.045 < 0.001
    术前末次总胆红素 0.022 0.009 5.489 1.022 1.004 ~ 1.041 0.019
    术后血液透析时间 0.032 0.010 9.736 1.033 1.012 ~ 1.054 0.002
    术后1 d Scr 0.012 0.004 9.872 1.012 1.005 ~ 1.020 0.002
    术后7 d Scr 0.003 0.002 3.126 1.003 1.000 ~ 1.006 0.077
    术后1 d脑钠肽前体 0.000 10 0.000 03 7.695 1.000 10 1.000 02 ~ 1.000 12 0.006
    注:①OR为比值比。
    CI为可信区间。
    下载: 导出CSV
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  • 收稿日期:  2022-08-26
  • 网络出版日期:  2023-01-17
  • 刊出日期:  2023-01-15

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