【摘要】：目的：研究低鉀血癥在腹膜透析患者中的發(fā)生率及其相關(guān)因素。 方法：選取2013年11月-2014年3月我院腹膜透析中心規(guī)律門診隨診的CAPD患者及腎內(nèi)科住院的CAPD患者60例，采用橫斷面方法研究，并分析這60例患者在該期間的臨床資料及血生化檢查結(jié)果。根據(jù)患者的血鉀水平，將患者分為正常血鉀組（血鉀3.5mmol/l～5.5mmol/l）44例和低鉀血癥組（血鉀＜3.5mmol/L）16例。在臨床數(shù)據(jù)、營養(yǎng)狀態(tài)、炎癥相關(guān)指標(biāo)、透析指標(biāo)、殘余腎功能、鉀沉降率、貧血、鈣磷代謝等方面將兩組患者進(jìn)行對比。計(jì)量數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差表示，構(gòu)成比選用百分比表示，分類變量選用頻數(shù)表示，兩獨(dú)立樣本t檢驗(yàn)用于計(jì)量資料的比較，卡方檢驗(yàn)和秩和檢驗(yàn)用于計(jì)數(shù)資料或等級資料的比較。采用相關(guān)分析尋找低鉀血癥發(fā)生的相關(guān)因素，兩變量服從雙變量正態(tài)分布的應(yīng)用Pearson相關(guān)，若兩變量不服從雙變量正態(tài)分布，或兩變量為多分類有序資料，應(yīng)用Spearman秩相關(guān)進(jìn)行相關(guān)分析，，最終將在單因素相關(guān)分析中有相關(guān)性(P0.05)的指標(biāo)放入Binary logistic回歸，探究致使低鉀血癥發(fā)生的相關(guān)因素。 結(jié)果：低鉀血癥在本研究中的發(fā)生率為26.67%。在單因素相關(guān)分析中發(fā)現(xiàn)，年齡、原發(fā)病為糖尿病腎病、血白蛋白、血前白蛋白、血磷、鈣磷乘積、CRP、腹膜KT/V、24h腹膜透析液鉀排出量、2hD/Pk（2h鉀沉降率）與血鉀水平有著相關(guān)性（p0.05），其中正相關(guān)的因素為血白蛋白、血前白蛋白、血磷、鈣磷乘積，負(fù)相關(guān)的因素為糖尿病腎病、年齡、CRP、腹膜KT/V、24h腹膜透析液鉀排出量、2hD/Pk；其他因素如SGA、腹膜透析轉(zhuǎn)運(yùn)類型、高糖透析液的使用情況、每天腹透液的超濾量、24h尿排鉀量、總KT/V、總Ccr、殘腎功能、4hD/Pk等方面無相關(guān)性（p＞0.05），進(jìn)一步行Binary logistic回歸分析顯示糖尿病腎病、腹膜KT/V、24h腹透液排鉀量均為低鉀血癥的危險(xiǎn)因素。 結(jié)論：1. CAPD患者中發(fā)生低鉀血癥的正相關(guān)因素為血白蛋白、血前白蛋白、血磷、鈣磷乘積，負(fù)相關(guān)的因素為糖尿病腎病、年齡、CRP、腹膜KT/V、24h腹膜透析液鉀排出量、2hD/Pk（2h鉀沉降率）。 2.CAPD患者中發(fā)生低鉀血癥的危險(xiǎn)因素為腹膜KT/V值、24h腹膜透析液排鉀量、糖尿病腎病。
[Abstract]:Objective: to study the incidence and related factors of hypokalemia in peritoneal dialysis patients. Methods: from November 2013 to March 2014, 60 patients with CAPD and 60 patients with CAPD in renal internal medicine department were selected and studied by cross-sectional method, which were followed up in the regular outpatient clinic of peritoneal dialysis center in our hospital from November 2013 to March 2014. The clinical data and blood biochemical examination results of 60 patients were analyzed. According to the serum potassium level, the patients were divided into normal potassium group (44 cases) and hypokalemia group (16 cases). The clinical data, nutritional status, inflammation related index, dialysis index, residual renal function, potassium sedimentation rate, anemia, calcium and phosphorus metabolism were compared between the two groups. The measurement data are expressed as mean 鹵standard deviation, composition ratio is expressed as percentage, classification variable is expressed by frequency, and two independent samples t test are used to compare measurement data. Chi-square test and rank sum test are used to compare counting data or rank data. Correlation analysis was used to find out the related factors of hypokalemia. Pearson correlation was used for the application of bivariate normal distribution. If the two variables were not obeyed from the bivariate normal distribution, or if the two variables were multi-classified and ordered data, The Spearman rank correlation was used to analyze the correlation and the correlation (P0.05) in the single factor correlation analysis was put into the Binary logistic regression to explore the related factors that led to hypokalemia. Results: the incidence of hypokalemia in this study was 26.67. Univariate correlation analysis showed that age, primary disease was diabetic nephropathy, serum albumin, serum prealbumin, serum phosphorus, calcium and phosphorus product, potassium excretion from peritoneal dialysis fluid of CRP, peritoneal KT/V,24h. There was a correlation between 2hD/Pk (2h potassium deposition rate) and serum potassium level (p0.05). The positive correlation factors were serum albumin, serum prealbumin, serum phosphorus, calcium and phosphorus product, and the negative correlation factors were diabetic nephropathy, age, CRP,. Peritoneal KT/V,24h peritoneal dialysate potassium excretion, 2hd / Pk; Other factors such as SGA, peritoneal dialysis transport type, use of high glucose dialysate, daily ultrafiltration of peritoneal dialysis fluid, 24 hours urinary potassium excretion, total KT/V, total Ccr, residual renal function, 4hD/Pk were not correlated (p > 0. 05). Further Binary logistic regression analysis showed that potassium excretion from peritoneal KT/V,24h peritoneal dialysate was the risk factor of hypokalemia in diabetic nephropathy. Conclusion: 1. The positive correlation factors of hypokalemia in CAPD patients were serum albumin, serum prealbumin, serum phosphorus, calcium and phosphorus product. The negative correlation factors were diabetic nephropathy, age, CRP, peritoneal KT/V,24h peritoneal dialysate potassium excretion. 2hD/Pk (2h potassium deposition rate). The risk factors of hypokalemia in 2.CAPD patients were peritoneal KT/V, 24 h peritoneal dialysis solution potassium excretion and diabetic nephropathy.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5

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