维持性血液透析患者高钾血症的相关因素分析及环硅酸锆钠散辅助干预效果研究

摘要 目的：分析维持性血液透析（MHD）患者高钾血症的相关因素，并观察环硅酸锆钠散辅助干预效果。方法：纳入我院2020年3月~2022年3月期间收治的MHD患者134例，通过本院病历系统收集患者资料，以是否出现高钾血症作为分组标准：分为血钾正常组（n=49）和高钾血症组（n=85），多因素Logistic回归分析MHD患者发生高钾血症的相关因素。采用随机数字表法将高钾血症组患者分为对照组（接受MHD治疗）和观察组（MHD治疗基础上接受环硅酸锆钠散干预，比较两组高钾血症干预前后相关指标和不良反应发生情况。结果：134例MHD患者中血钾正常49例（36.57%）纳入血钾正常组，高钾血症85例（63.43%）纳入高钾血症组。单因素分析结果显示，MHD患者高钾血症与甲状旁腺激素（PTH）、合并糖尿病、既往高钾血症史、透析前血钾检验次数、超滤量、血流量、血红蛋白（Hb）、超敏C反应蛋白（hs-CRP）、尿素、尿酸、血肌酐、血钠、白蛋白、血磷有关（P<0.05）。多因素Logistic回归分析结果显示：尿素偏高、血钠偏高、血磷偏高、白蛋白偏高、Hb偏高、合并糖尿病、透析前血钾检验次数偏少是MHD患者高钾血症发生的危险因素（P<0.05）。对照组与观察组干预后血钾均降低，且观察组低于对照组（P<0.05）。对照组、观察组不良反应发生率组间对比无统计学差异（P>0.05）。结论：MHD患者高钾血症的相关因素主要有尿素、血钠、血磷、白蛋白、Hb、合并糖尿病、透析前血钾检验次数。应用环硅酸锆钠散辅助干预高钾血症患者，可有效改善其血钾水平，安全有效。

Analysis of the Related Factors of Hyperkalemia in Maintenance Hemodialysis Patients and the Curative Effect of Adjuvant Intervention with Sodium Zirconate Cyclosilicate Powder

ABSTRACT Objective: To analyze the related factors of hyperkalemia in maintenance hemodialysis (MHD) patients, and observe the curative Effect of adjuvant intervention with sodium zirconate cyclosilicate powder. Methods: 134 MHD patients who were admitted to our hospital from March 2020 to March 2022 were included. Patient data were collected through our hospital''s medical record system, and the occurrence of hyperkalemia was used as the grouping criteria: they were divided into normal blood potassium group (n=49) and hyperkalemia group (n=85). Multivariate Logistic regression analysis was used to analyze the related factors of hyperkalemia in MHD patients. Patients in hyperkalemia group were divided into control group (receiving MHD treatment) and observation group (receiving sodium zirconate cyclosilicate powder on the basis of MHD intervention) by random number table method. The relevant indexes and adverse reactions before and after hyperkalemia intervention were compared in the two groups. Results: Among 134 MHD patients, 49 (36.57%) with normal blood potassium were included in the normal blood potassium group, and 85 (63.43%) with hyperkalemia were included in the hyperkalemia group. The results of univariate analysis showed that hyperkalemia in MHD patients was related to parathyroid hormone (PTH), combined with diabetes, previous history of hyperkalemia, the number of blood potassium tests before dialysis, ultrafiltration volume, blood flow volume, hemoglobin (Hb), high-sensitivity C-reactive protein (hs-CRP), urea, uric acid, blood creatinine, blood sodium, albumin, and blood phosphorus (P<0.05). The results of multivariate Logistic regression analysis showed that higher urea, higher blood sodium, higher blood phosphorus, higher albumin, higher Hb, combined with diabetes, and less blood potassium tests before dialysis were the risk factors for hyperkalemia in MHD patients (P<0.05). The blood potassium in the control group and the observation group after intervention decreased, and the observation group was lower than the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the control group and the observation group (P>0.05). Conclusion: The main related factors to hyperkalemia in MHD patients are urea, blood sodium, blood phosphorus, albumin, Hb, combined with diabetes, and the number of blood potassium tests before dialysis. The application of sodium zirconate cyclosilicate powder adjunctive intervention in the treatment of hyperkalemia can effectively improve the blood potassium level, which is safe and effective.