内分泌代谢科住院患者低钾血症的回顾性分析

发布时间：2018-04-16 09:21

本文选题：低钾血症 + 治疗　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：观察内分泌代谢科住院患者低钾血症(Hypokalemia,简称HK)的致病原因、临床表现和转归，并探究其发病机制，分析内分泌相关性HK的特征、诊断及鉴别诊断，进而指导临床上对HK的预防和诊疗。方法：选取我院2008年5月~2010年12月和2012年7月~2014年10月明确诊断为HK的内分泌代谢科住院患者共601例。根据入院后初测血钾水平分轻度低血钾（血钾3.0~3.5mmol/L）、中度低血钾（血钾2.5~3.0mmol/L）、重度低血钾（血钾2.5mmol/L）。收集记录每位患者的一般资料信息、原发病、住院时间、临床表现、生化指标（血钠、血钾、血氯、血钙、肌酐、血白蛋白、血糖、低密度脂蛋白胆固醇、甘油三酯胆固醇、24小时尿钾）。一些特殊病因导致HK时记录相关特异性的检查及检验结果。分析每组患者患病原因、临床特点及转归情况。结果：（1）5年间我院内分泌代谢科住院患者HK的发病率为5.7%，其中轻度、中度、重度HK所占比例分别为58.74%、30.11%、11.14%。（2）重度HK患者平均年龄较轻度及中度HK组年龄小，差异有统计学意义（P0.05）。（3）轻度HK患者平均住院时间较中度及重度时间长，但差异无统计学意义（P0.05）。（4）重度HK患者平均血糖较轻中度组控制好，差异有统计学意义（P0.05）。（5）导致HK前3位病因为糖尿病最常见（70.88%）、甲状腺功能亢进症（7.99%）、药物性低钾血症（4.67%）。（6）本研究中因原发疾病就诊而发现HK者比例最高占56.4%，其次为肌肉症状（如乏力等）占36.71%，其他症状占6.9%。（7）轻度HK患者较中度、重度HK者转归好，，且差异有统计学意义（P0.05）。（8）601例患者中，有514例为内分泌代谢疾病相关性HK，由糖尿病所致者为数最多，87例非内分泌相关性HK中，因应用药物所致的HK者最多。（9）在内分泌代谢疾病中肾小管酸中毒所致的HK患者重度HK所占比例最大，糖尿病所致的HK患者重度HK所占比例最小（5.6%）。结论：（1）内分泌代谢科住院患者中低钾血症的常见原因为糖尿病，大多数因院外疾病控制不良或并发症，出现药物性低钾血症、摄入不足、胃肠道丢失。另外部分患者在内分泌代谢疾病基础上，伴发其他疾病，如胃肠道疾病等。（2）内分泌相关性低钾血症的常见原因为甲状腺疾病，其中甲状腺功能亢进症是导致HK的最常见原因。（3）在肾上腺疾病中原发性醛固酮增多症是导致HK的常见原因。（4）在内分泌代谢疾病中肾小管酸中毒为重度低钾血症的常见原因。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R591.1

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