醛固酮腺瘤肾上腺切除术后并发高钾血症的影响因素

发布时间：2018-02-09 05:49

本文关键词： 原发性醛固酮增多症醛固酮腺瘤高钾血症　出处：《福建中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的和意义：原发性醛固酮增多症(PA)是继发性高血压最常见的病因,肾上腺醛固酮腺瘤(APA)是原发性醛固酮增多症的常见类型,肾上腺切除手术是肾上腺醛固酮腺瘤的主要治疗方式,肾上腺切除手术可以导致术后短时间内醛固酮浓度低而出现术后高钾血症,本研究旨在明确肾上腺醛固酮腺瘤术后出现高钾血症的影响因素,从而尽可能的避免出现术后高钾血症,减少个人和社会的健康经济损失,另外,探讨肾上腺醛固酮腺瘤切除手术对血压、肾功能和电解质的影响,帮助临床医师谨慎的选择治疗方案。研究方法：本研究采取回顾性研究,通过阅读国内外文献明确肾上腺醛固酮腺瘤术后血钾的可能影响因素,收集2009年1月—2015年7月于福建省立医院符合纳入标准的病例共119例,收集记录研究需要的临床资料,根据术后血钾情况分成4组,对这4组的临床资料运用统计学方法分析醛固酮腺瘤肾上腺切除术后血钾的影响因素和明确肾上腺切除术对血压、肾功能和电解质的影响。对计量资料符合正态分布的运用单因素方差分析,不符合正态分布的运用Kruskal-Wallis检验,对计数资料进行卡方检验,术前-术后临床资料的比较运用配对t检验,所有统计学分析运用SPSS 20.0进行,P0.05有统计学意义。结果：(1)在119例单侧肾上腺醛固酮腺瘤手术的病例中术后血钾较高者(术后血钾大于5.0mmol/l)有6例,占总体的5%,这6例的平均血钾水平为5.38±0.38mmol/l;(2)将119例单侧肾上腺醛固酮腺瘤的病例根据术后血钾情况分为4组,将收集到的对术后血钾有可能的影响因素进行单因素方差分析和Kruskal-Wallis检验分析,结合单因素方差分析和Kruskal-Wallis检验分析结果,进一步将对术后血钾的可能影响因素进行有序多分类logistic回归分析,得到年龄、术前醛固酮、术后血钙、术后血磷、术后GFR和术后肌酐对术后血钾的影响有统计学意义；(3)将术前-术后血压、肾功能和电解质情况进行配对t检验,得到统计学结果表明通过肾上腺切除手术可以降低血压,增加肾功能损害,可以升高血钾、血磷,降低血钠、血钙。结论：影响单侧醛固酮腺瘤术后血钾的因素有年龄、术前醛固酮、术后血钙、术后血磷、术后肌酐、术后GFR；单侧醛固酮腺瘤经过肾上腺切除手术治疗可以降低血压,短期内增加肾功能损害,可以升高血钾、血磷,降低血钠、血钙。
[Abstract]:Objective and significance: primary aldosteronism (PAA) is the most common cause of secondary hypertension, and adrenal aldosterone adenoma (APA) is a common type of primary aldosteronism. Adrenalectomy is the main treatment for adrenal aldosterone adenoma. Adrenalectomy can lead to low aldosterone concentration and hyperkalemia in a short period of time. The aim of this study was to identify the influencing factors of hyperkalemia after adrenal aldosterone adenoma, so as to avoid hyperkalemia and reduce personal and social health and economic loss. To investigate the effect of aldosterone adenoma resection on blood pressure, renal function and electrolyte, and to help clinicians to choose the treatment plan carefully. By reading the literature at home and abroad to determine the possible influencing factors of serum potassium in patients with adrenal aldosterone adenoma, 119 cases were collected from January 2009 to July 2015 in Fujian Provincial Hospital to record the clinical data needed for the study. The clinical data of the four groups were divided into 4 groups according to the postoperative potassium status. The influence factors of serum potassium after adrenal resection of aldosterone adenoma and the blood pressure after adrenalectomy were analyzed by statistical method. Effects of renal function and electrolytes. Univariate ANOVA was used to measure the normal distribution, Kruskal-Wallis test was used to measure the normal distribution, chi-square test was performed on the counting data. Preoperative and postoperative clinical data were compared by paired t test. All statistical analyses were performed with SPSS 20.0 for P05. Results among 119 patients with unilateral adrenal aldosterone adenoma, 6 had higher serum potassium (K > 5.0 mmol / L). The average serum potassium level of these 6 patients was 5.38 卤0.38 mmol / L ~ (2). 119 cases of unilateral adrenal aldosterone adenoma were divided into 4 groups according to the postoperative potassium status. The results of univariate ANOVA and Kruskal-Wallis test were combined with the results of univariate ANOVA and Kruskal-Wallis test. The possible factors influencing the postoperative serum potassium were further analyzed by logistic regression analysis in order to obtain age, preoperative aldosterone, postoperative serum calcium and postoperative phosphorus. The effect of postoperative GFR and postoperative creatinine on postoperative serum potassium was statistically significant (P < 0.05) the blood pressure, renal function and electrolytes were matched to t test before and after operation, and the results showed that the blood pressure could be lowered by adrenalectomy. Increase of renal function damage can increase blood potassium, blood phosphorus, decrease blood sodium, blood calcium. Conclusion: the factors affecting serum potassium after unilateral aldosterone adenoma are age, preoperation aldosterone, postoperative blood calcium, postoperative blood phosphorus, postoperative creatinine. Postoperative GFR: unilateral aldosterone adenoma can lower blood pressure, increase renal function damage, increase blood potassium, blood phosphorus, decrease blood sodium and calcium after adrenalectomy.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R699.3

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