本文選題：低鉀血癥 + 治療�。� 參考：《吉林大學》2015年碩士論文

【摘要】：目的：觀察內(nèi)分泌代謝科住院患者低鉀血癥(Hypokalemia,簡稱HK)的致病原因、臨床表現(xiàn)和轉(zhuǎn)歸，并探究其發(fā)病機制，分析內(nèi)分泌相關性HK的特征、診斷及鑒別診斷，進而指導臨床上對HK的預防和診療。 方法：選取我院2008年5月~2010年12月和2012年7月~2014年10月明確診斷為HK的內(nèi)分泌代謝科住院患者共601例。根據(jù)入院后初測血鉀水平分輕度低血鉀（血鉀3.0~3.5mmol/L）、中度低血鉀（血鉀2.5~3.0mmol/L）、重度低血鉀（血鉀2.5mmol/L）。收集記錄每位患者的一般資料信息、原發(fā)病、住院時間、臨床表現(xiàn)、生化指標（血鈉、血鉀、血氯、血鈣、肌酐、血白蛋白、血糖、低密度脂蛋白膽固醇、甘油三酯膽固醇、24小時尿鉀）。一些特殊病因?qū)е翲K時記錄相關特異性的檢查及檢驗結(jié)果。分析每組患者患病原因、臨床特點及轉(zhuǎn)歸情況。 結(jié)果：（1）5年間我院內(nèi)分泌代謝科住院患者HK的發(fā)病率為5.7%，其中輕度、中度、重度HK所占比例分別為58.74%、30.11%、11.14%。（2）重度HK患者平均年齡較輕度及中度HK組年齡小，差異有統(tǒng)計學意義（P0.05）。（3）輕度HK患者平均住院時間較中度及重度時間長，但差異無統(tǒng)計學意義（P0.05）。（4）重度HK患者平均血糖較輕中度組控制好，差異有統(tǒng)計學意義（P0.05）。（5）導致HK前3位病因為糖尿病最常見（70.88%）、甲狀腺功能亢進癥（7.99%）、藥物性低鉀血癥（4.67%）。（6）本研究中因原發(fā)疾病就診而發(fā)現(xiàn)HK者比例最高占56.4%，其次為肌肉癥狀（如乏力等）占36.71%，其他癥狀占6.9%。（7）輕度HK患者較中度、重度HK者轉(zhuǎn)歸好，，且差異有統(tǒng)計學意義（P0.05）。（8）601例患者中，有514例為內(nèi)分泌代謝疾病相關性HK，由糖尿病所致者為數(shù)最多，87例非內(nèi)分泌相關性HK中，因應用藥物所致的HK者最多。（9）在內(nèi)分泌代謝疾病中腎小管酸中毒所致的HK患者重度HK所占比例最大，糖尿病所致的HK患者重度HK所占比例最�。�5.6%）。 結(jié)論：（1）內(nèi)分泌代謝科住院患者中低鉀血癥的常見原因為糖尿病，大多數(shù)因院外疾病控制不良或并發(fā)癥，出現(xiàn)藥物性低鉀血癥、攝入不足、胃腸道丟失。另外部分患者在內(nèi)分泌代謝疾病基礎上，伴發(fā)其他疾病，如胃腸道疾病等。（2）內(nèi)分泌相關性低鉀血癥的常見原因為甲狀腺疾病，其中甲狀腺功能亢進癥是導致HK的最常見原因。（3）在腎上腺疾病中原發(fā)性醛固酮增多癥是導致HK的常見原因。（4）在內(nèi)分泌代謝疾病中腎小管酸中毒為重度低鉀血癥的常見原因。
[Abstract]:Objective: to observe the etiology, clinical manifestation and outcome of hypokalemia (HK) in patients with hypokalemia in Department of Endocrine and Metabolism, explore its pathogenesis, analyze the characteristics, diagnosis and differential diagnosis of endocrine related HK.And then guide the clinical prevention and treatment of HK.Methods: from May 2008 to December 2010 and from July 2012 to October 2014, a total of 601 patients from endocrine and metabolism department diagnosed as HK were selected.There were mild hypokalemia (3.0 ~ 3.5mmol / L), moderate hypokalemia (2.5 ~ 3.0 mmol / L) and severe hypokalemia (2.5 mmol / L).To collect and record the general information of each patient, the primary disease, the length of stay in hospital, the clinical manifestation, the biochemical indexes (blood sodium, blood potassium, blood chlorine, serum calcium, creatinine, serum albumin, blood glucose, low density lipoprotein cholesterol, etc.Triglyceride cholesterol in 24 hours urine potassium.Specific examination and test results were recorded at HK time due to some special causes.The causes, clinical characteristics and outcome of each group were analyzed.Results the incidence of HK in the department of endocrinology and metabolism in our hospital during the past 5 years was 5.7. The proportion of mild, moderate and severe HK was 58.740.11 / 11.14. The average age of the patients with severe HK was lower than that of the mild and moderate HK groups, and the average age of the patients with severe HK was lower than that of the mild and moderate HK groups.The average hospitalization time of mild HK patients was longer than that of moderate and severe patients, but the difference was not statistically significant.The difference is statistically significant (P 0.05. 5)) the top three causes of HK are the most common causes of diabetes mellitus: 70.88%, hyperthyroidism 7.99%, and hypokalemia 4.67%. 6) in this study, the highest proportion of HK was found because of primary diseases, followed by musculositis.Symptoms (such as fatigue) accounted for 36.71%, other symptoms accounted for 6.9%) mild HK patients were moderate,Among the 601 patients with severe HK, 514 were related to endocrine and metabolic diseases, and the most of them were caused by diabetes mellitus (n = 87).The proportion of HK patients with renal tubular acidosis caused by renal tubule acidosis was the largest, and that of diabetic patients with HK patients was the lowest (5.6g%).Conclusion (1) the common cause of hypokalemia in patients in endocrine and metabolism department is diabetes mellitus. Most of them have drug-induced hypokalemia, insufficient intake and gastrointestinal tract loss due to poor control of diseases outside hospital or complications.On the basis of endocrine and metabolic diseases, other diseases, such as gastrointestinal diseases and other hypokalemia, are common causes of hypokalemia.Hyperthyroidism is the most common cause of HK.) among adrenal diseases, primary aldosteronism is the most common cause. 4) in endocrine and metabolic diseases, renal tubular acidosis is a common cause of severe hypokalemia.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R591.1

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