中国血液净化

›› 2007, Vol. 6 ›› Issue (5): 260-262.

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透析液钾浓度对血液透析患者QT间期及QT离散度的影响

魏迎凤1 王爱萍1 张小梅1 徐学康1 邹毓斌2   

  1. 1. 260006 南通，南通大学附属南通第三医院血液净化中心 2. 心内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-05-12 发布日期:2007-05-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-05-12 Published:2007-05-12

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摘要： 目的 探讨透析液钾浓度变化对血液透析患者QT间期及QT离散度的影响。方法 选择南通大学附属南通第三医院血液净化中心60例慢性肾衰竭长期维持性血液透析患者先后应用钾浓度为2.0 mmol/L, 3.0mmol/L的透析液各进行1次血液透析，分别记录临床及实验室指标，采用12导联同步记录透析中(透析至4h)心电图测量并计算QT间期(QT)及QT离散度(QTd)。结果 采用钾浓度3.0mmol/L透析液血液透析时， QT间期由钾浓度2.0mmol/L透析时(595.51±39.01)ms缩短为(540.61±44.63)ms，QTd由(63.27±8.46)ms缩短为(53.46±8.83)ms，两者差异均有统计学意义；心律失常的发生率明显降低(P＜0.01)，差异有统计学意义。采用相同钾浓度透析液透析时透析前血钾浓度＜3.5mmol/L患者QTd较血钾浓度≥3.5mmol/L患者长，差异有统计学意义(P＜0.05)。结论 QTd反映心室复极的不均一性和电不稳定性，采用钾浓度3.0mmol/L透析液进行透析可缩短QT间期及QTd，降低心律失常的发生率。防治透析前低血钾也可缩短QTd，减少透析中心律失常的发生率。

关键词: 血液透析, 透析液钾浓度, QT间期, QT离散度, 心律失常

Abstract: Objectives To observe K+ concentration in dialysate on QT interval and QT scatter degree (QTd) of the patients on maintenance hemodialyis. Methods Sixty cases with chronic renal failure on maintenance hemodialyis were observed, in which dialysates containing 2.0mmol/l and 3.0mmol/l K+ were alternatively used once for a patient. Clinical observation and laboratory examinations were performed. QT interval and QTd from their electrocardiograms were measured after the dialysis for 4 hours. Results After using dialysate containing 2.0mmol/l K+, QT interval and QTd ranged in (595.51±39.01)ms and (63.27 8.46)ms, respectively. When dialysate containing 3.0mmol/l K+ was used, QT interval shortened to (540.61±44.63)ms and QTd to (53.46 8.83)ms. Cardiac arrhythmia was infrequently found in those using 3.0mmol/l K+ in dialysate (P <0.01). When the same K+ concentration in dialysate was used, QTd was greater in patients with pre-dialysis serum K+ <3.5 mmol/l than those with K+ >3.5 mmol/l (P < 0.05). Conclusion Larger QTd reflects the ununiformity and electric instability of ventricular repolarization. Dialysate containing 3.0mmol/l K+ decreases the QT and QTd values and is helpful in the prevention of arrhythmia. Treatment of hypopotassemia before dialysis will reduce the QTd value as well as the risk of arrhythmia during dialysis.

Key words: Potassium concentration in dialysate, QT interval, QT scatter degree, Arrhythmia

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