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1、2017/7/91公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital儿童高钾及低钾血症儿童高钾及低钾血症 的危重处置要点的危重处置要点2017/7/92公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Chi
2、ldrens s HospitalHospital2017/7/92公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital概述概述 骨骼肌内浓度可140150mEq/L2017/7/93公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Heal
3、th, Beijing Childrens s HospitalHospital2017/7/93公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital钾平衡钾平衡 钾的需求量与热卡比值：2mEq/100kcal2017/7/94公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health,
4、Beijing Childrens Health, Beijing Childrens s HospitalHospital2017/7/94公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital钾平衡钾平衡 近曲小管和Henle袢 远曲小管和集合管主动排泌 排泌量与摄入量、远曲小管和集合管细胞中氢离子浓度、钠离子重吸收等相关 肾脏不能在未摄入钾的情况下停止机体对钾的消耗肾脏不
5、能在未摄入钾的情况下停止机体对钾的消耗如果机体突然摄入 大量钾，组织细胞 将使80%进入血中 的钾进入细胞内2017/7/95公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital2017/7/95公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Children
6、s Health, Beijing Childrens s HospitalHospital钾平衡钾平衡 2个钾离子泵入细胞内，3个钠离子泵到细胞外，使细胞膜上产生电化学梯度 多因素可以影响该泵的活性，如胰岛素、胰高血糖素、儿茶酚胺、醛固酮、酸碱平衡状态、血浆渗透压、细胞内钾离子浓度等2017/7/96公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital2017/7/96公慈
7、公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital钾平衡的调节钾平衡的调节2017/7/97公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital2017/7/
8、97公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital钾离子的生理功能钾离子的生理功能 每合成1g糖原约需0.15mmol钾，合成1g蛋白质需0.45mmol钾 细胞膜内外钾离子浓度决定神经肌肉细胞的静息电位 血清钾浓度很低，如细胞内仅1%的钾进入细胞外液，尤其是心肌细胞，即可发生传导异常甚至致死性心律失常2017/7/98公慈公慈 勤和勤和National Center
9、for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital高钾血症高钾血症（HYPERKALEMIAHYPERKALEMIA）2017/7/99公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital2017/7/9
10、9公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital高钾血症定义高钾血症定义2017/7/910公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital201
11、7/7/910公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital高钾血症病因高钾血症病因钾的摄入和排泄失衡钾在细胞内外分布异常ICU患者高钾血症常见原因2017/7/911公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, B
12、eijing Childrens s HospitalHospital2017/7/911公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital高钾血症病因高钾血症病因静脉或口服补钾输血（随血细胞贮存时间延长其风险增加）急慢性肾功能不全：GFR下降（尤其是15ml/min/1.73m2时）原发（如Addison病）或继发性低醛固酮症（如慢性肾功能衰竭）肾素分泌减少先天性肾上腺皮
13、质增生症假性低醛固酮症充血性心力衰竭IV型肾小管性酸中毒酸中毒引起钾离子再分布高钾性家族性周期性麻痹糖尿病急性组织细胞破坏（烧烫伤、中暑、创伤、挤压伤、横纹肌溶解、肿瘤溶解综合征、溶血、大量输血、溶血尿毒综合征、组织坏死等）采血时使用止血带或取血困难致标本溶血样本被污染血细胞增多（白细胞计数50000/mm3或血小板1000000/mm3，主要影响血清钾，而非血浆钾浓度）2017/7/912公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Be
14、ijing Childrens s HospitalHospital2017/7/912公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital高钾血症病因高钾血症病因分类分类药物药物钾摄入增加钾摄入增加氯化钾青霉素钾钾排出减少钾排出减少保钾利尿剂（如安体舒通、氨苯蝶啶、阿米洛利）环孢素血管紧张素转换酶抑制剂（ACEI）非甾体类抗炎药物肝素他克莫司甲氧苄氨嘧啶地高辛、受体阻滞剂、
15、钙通道阻滞剂甘露醇2017/7/913公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital2017/7/913公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospi
16、tal高钾血症临床表现高钾血症临床表现2017/7/914公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital2017/7/914公慈公慈 勤和勤和National Center for ChildrenNational Center for Childrens Health, Beijing Childrens Health, Beijing Childrens s HospitalHospital高钾血症的心电图改变高钾血症的心电图改变高钾血症高钾血症心电图心电图5.56.5mEq/LT波高尖，PR间期
