持续性不卧床腹膜透析患者低钾血症的相关因素研究

发布时间：2019-01-24 21:59

【摘要】：目的：研究低钾血症在腹膜透析患者中的发生率及其相关因素。方法：选取2013年11月-2014年3月我院腹膜透析中心规律门诊随诊的CAPD患者及肾内科住院的CAPD患者60例，采用横断面方法研究，并分析这60例患者在该期间的临床资料及血生化检查结果。根据患者的血钾水平，将患者分为正常血钾组（血钾3.5mmol/l～5.5mmol/l）44例和低钾血症组（血钾＜3.5mmol/L）16例。在临床数据、营养状态、炎症相关指标、透析指标、残余肾功能、钾沉降率、贫血、钙磷代谢等方面将两组患者进行对比。计量数据以均数±标准差表示，构成比选用百分比表示，分类变量选用频数表示，两独立样本t检验用于计量资料的比较，卡方检验和秩和检验用于计数资料或等级资料的比较。采用相关分析寻找低钾血症发生的相关因素，两变量服从双变量正态分布的应用Pearson相关，若两变量不服从双变量正态分布，或两变量为多分类有序资料，应用Spearman秩相关进行相关分析，，最终将在单因素相关分析中有相关性(P0.05)的指标放入Binary logistic回归，探究致使低钾血症发生的相关因素。结果：低钾血症在本研究中的发生率为26.67%。在单因素相关分析中发现，年龄、原发病为糖尿病肾病、血白蛋白、血前白蛋白、血磷、钙磷乘积、CRP、腹膜KT/V、24h腹膜透析液钾排出量、2hD/Pk（2h钾沉降率）与血钾水平有着相关性（p0.05），其中正相关的因素为血白蛋白、血前白蛋白、血磷、钙磷乘积，负相关的因素为糖尿病肾病、年龄、CRP、腹膜KT/V、24h腹膜透析液钾排出量、2hD/Pk；其他因素如SGA、腹膜透析转运类型、高糖透析液的使用情况、每天腹透液的超滤量、24h尿排钾量、总KT/V、总Ccr、残肾功能、4hD/Pk等方面无相关性（p＞0.05），进一步行Binary logistic回归分析显示糖尿病肾病、腹膜KT/V、24h腹透液排钾量均为低钾血症的危险因素。结论：1. CAPD患者中发生低钾血症的正相关因素为血白蛋白、血前白蛋白、血磷、钙磷乘积，负相关的因素为糖尿病肾病、年龄、CRP、腹膜KT/V、24h腹膜透析液钾排出量、2hD/Pk（2h钾沉降率）。 2.CAPD患者中发生低钾血症的危险因素为腹膜KT/V值、24h腹膜透析液排钾量、糖尿病肾病。
[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 卤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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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