新定义!血钾>5.0 mmol/L为高钾血症!心衰患者高钾血症怎么治?

2021-11-29 MedSci原创 MedSci原创

来看看新共识怎么说!

心力衰竭(简称心衰)是各种心脏疾病的严重和终末阶段,是21世纪最重要的心血管疾病之一。而心衰的发生发展是一个复杂的过程,离子异常与心衰患者的不良预后密切相关,影响心衰患者的治疗。而高钾血症是心衰常见的并发症,可导致严重的心率失常,甚至危及生命。

近日,中国医师协会心内科医师分会心衰学组发布了《中国心力衰竭患者高钾血症管理专家共识》(以下简称共识),重新定义了高钾血症的阈值,临床表现,诊断以及治疗等,为心衰合并高钾血症患者的综合管理提供指导。

那么,共识具体包含了哪些核心内容呢?一起来看看~

核心内容1:血钾>5.0 mmol/L即诊断为高钾血症

正常人血清钾离子(血钾)浓度为3.5~5.5 mmol/L,心衰患者的理想血钾水平为4.0~5.0 mmol/L,而当血钾>5.0 mmol/L时,心衰患者死亡风险明显升高,因此建议血钾水平>5.0 mmol/L即可诊断为高钾血症。

根据血钾浓度,将高钾血症分为轻度、中度和重度。轻度高钾血症血钾浓度为5~5.5 mmol/L、中度高钾血症血钾浓度为5.6~6.0 mmol/L、重度高钾血症血钾浓度为>6.0 mmol/L

根据病情轻重,将高钾血症分为急性和慢性。急性高钾血症是血钾在短时间内升高,超过5.0 mmol/L。慢性高钾血症则为在1年内高钾血症(血钾>5.0 mmol/L)反复发作。

核心内容2:高钾血症病因

药物作用:长期应用肾素-血管紧张素-醛固酮系统抑制剂(RAASi)、 β受体阻滞剂,以及其他相关药物,如强心药、抗生素、肝素或非类固醇类药物(NSAID)等;

心衰合并症:糖尿病、慢性肾脏病

饮食:富含钾离子的低钠盐、富含钾离子的果蔬和食品添加剂等

核心内容3:高钾血症临床表现

最初的心电图改变为T波高尖和QT间期缩短,后逐渐出现QRS波增宽伴波幅降低、P波消失,最后QRS波显著增宽呈正弦波形。值得注意的是,高钾血症的心电图演变和严重程度可能不完全与血钾浓度平行,少数患者并无心电图的前驱变化而直接表现为猝死。

心脏外表现可表现为神经肌肉兴奋性升高、肌细胞失去兴奋性,中枢神经表现为烦躁不安、神志不清。此外还有一些其他的表现,包括恶心、呕吐和腹痛等消化道症状。

核心内容4:高钾血症诊断

在诊断高钾血症时,必须除外血液采样、送检等操作不当引起溶血所致的假性高钾血症。若有怀疑,建议重复送检以明确诊断,避免作出错误的临床处理。

在诊断高钾血症时,药物使用的梳理也必不可少,找出可导致血钾升高的药物

高钾血症的临床检验包括血/尿常规、肝/肾功能、电解质、血糖、肌酶和血气分析等,必要时完善血肾素-血管紧张素-醛固酮、尿电解质等指标检测

核心内容5:高钾血症一般治疗

心衰患者确诊高钾血症后,应全面评估合并症、用药和饮食情况。在饮食治疗方面,对于血钾>5.0 mmol/L以及慢性高钾血症患者,适当限制高钾食物的摄入,如含钾的低钠盐、橘、橙、土豆、西红柿等高钾食物的摄入。

鉴于控制饮食可能会导致膳食纤维和多种营养素摄入不足,共识指出,不建议过分严格地执行低钾饮食,而是应该长期口服降钾药物维持血钾稳定。

血钾>5.5 mmol/L可酌情减量并应用降钾药物,除非血钾>6.5 mmol/L或有高钾血症相关的危急情况,否则不宜贸然停用,建议在降钾药物维持血钾稳定下足量合理使用。

核心内容6:高钾血症急性的治疗

稳定心肌细胞膜电位:静脉使用钙剂可作为高钾血症的急诊一线处理。

促进细胞外的钾离子向细胞内转运:胰岛素+葡萄糖或者碳酸氢钠是常用的治疗方案。

促进钾离子排出体外:主要包括排钾利尿剂、阳离子交换树脂、新型钾离子结合剂和血液净化治疗。

核心内容7:慢性高钾血症的治疗

需要长期使用降钾药物维持血钾稳定,除了一般治疗和饮食建议之外,可以采取药物干预,比如排钾利尿剂、碳酸氢钠等

对于肾功能极差、反复发作高钾血症的心力衰竭患者,可采用长期透析的方法进行治疗。

参考文献:

中国医师协会心血管内科医师分会心力衰竭学组, 中国心力衰竭患者高钾血症管理专家共识工作组. 中国心力衰竭患者高钾血症管理专家共识 [J] . 中华医学杂志, 2021, 101(42) : 3451-3458. DOI: 10.3760/cma.j.cn112137-20210624-01430.

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    2023-02-16 ms2000002093440175 来自北京

    共识也能有PDF下载学习么#共识#

    0

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    2022-09-12 ms6000000755974223

    学习了

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=2114866, encodeId=55b92114866d3, content=共识也能有PDF下载学习么<a href='/topic/show?id=60813003990' target=_blank style='color:#2F92EE;'>#共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30039, encryptionId=60813003990, topicName=共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08398484237, createdName=ms2000002093440175, createdTime=Thu Feb 16 09:11:50 CST 2023, time=2023-02-16, status=1, ipAttribution=北京), GetPortalCommentsPageByObjectIdResponse(id=1248563, encodeId=b6821248563d7, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=34446512602, createdName=ms6000000755974223, createdTime=Mon Sep 12 22:52:14 CST 2022, time=2022-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1949335, encodeId=b57219493352f, content=<a href='/topic/show?id=5ed95833172' target=_blank style='color:#2F92EE;'>#新定义#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58331, encryptionId=5ed95833172, topicName=新定义)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Fri Feb 04 01:51:07 CST 2022, time=2022-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219810, encodeId=10fb121981018, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=905d5399254, createdName=秋秋2, createdTime=Sun May 15 18:53:26 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1081404, encodeId=61cc1081404b0, content=专家共识,不同专家有不同看法,还是搞循证指南吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=b5925394177, createdName=萧山yd, createdTime=Sat Dec 18 01:14:51 CST 2021, time=2021-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1080250, encodeId=9c531080250df, content=是建议还是已经上了指南了?, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=808187458, createdName=gwhardaway, createdTime=Wed Dec 15 09:58:19 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077727, encodeId=886210e7727ae, content=了解了新内容, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a446388756, createdName=ms2000000602249923, createdTime=Tue Dec 07 13:09:36 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075803, encodeId=c2dc10e58034b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=50ec5699921, createdName=ms3000001712111982, createdTime=Wed Dec 01 10:49:21 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373553, encodeId=d3ff13e35537b, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Wed Dec 01 06:51:07 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514542, encodeId=ab371514542d3, content=<a href='/topic/show?id=102f102e8375' target=_blank style='color:#2F92EE;'>#高钾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102783, encryptionId=102f102e8375, topicName=高钾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5d010658633, createdName=ms7517674339485982, createdTime=Wed Dec 01 06:51:07 CST 2021, time=2021-12-01, status=1, ipAttribution=)]
    2022-05-15 秋秋2

    学习了

    0

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    2021-12-18 萧山yd

    专家共识,不同专家有不同看法,还是搞循证指南吧

    0

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    2021-12-15 gwhardaway

    是建议还是已经上了指南了?

    0

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    2021-12-07 ms2000000602249923

    了解了新内容

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2114866, encodeId=55b92114866d3, content=共识也能有PDF下载学习么<a href='/topic/show?id=60813003990' target=_blank style='color:#2F92EE;'>#共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30039, encryptionId=60813003990, topicName=共识)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08398484237, createdName=ms2000002093440175, createdTime=Thu Feb 16 09:11:50 CST 2023, time=2023-02-16, status=1, ipAttribution=北京), GetPortalCommentsPageByObjectIdResponse(id=1248563, encodeId=b6821248563d7, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=34446512602, createdName=ms6000000755974223, createdTime=Mon Sep 12 22:52:14 CST 2022, time=2022-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1949335, encodeId=b57219493352f, content=<a href='/topic/show?id=5ed95833172' target=_blank style='color:#2F92EE;'>#新定义#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58331, encryptionId=5ed95833172, topicName=新定义)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Fri Feb 04 01:51:07 CST 2022, time=2022-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219810, encodeId=10fb121981018, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=905d5399254, createdName=秋秋2, createdTime=Sun May 15 18:53:26 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1081404, encodeId=61cc1081404b0, content=专家共识,不同专家有不同看法,还是搞循证指南吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=b5925394177, createdName=萧山yd, createdTime=Sat Dec 18 01:14:51 CST 2021, time=2021-12-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1080250, encodeId=9c531080250df, content=是建议还是已经上了指南了?, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=808187458, createdName=gwhardaway, createdTime=Wed Dec 15 09:58:19 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077727, encodeId=886210e7727ae, content=了解了新内容, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a446388756, createdName=ms2000000602249923, createdTime=Tue Dec 07 13:09:36 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075803, encodeId=c2dc10e58034b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=50ec5699921, createdName=ms3000001712111982, createdTime=Wed Dec 01 10:49:21 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373553, encodeId=d3ff13e35537b, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Wed Dec 01 06:51:07 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514542, encodeId=ab371514542d3, content=<a href='/topic/show?id=102f102e8375' target=_blank style='color:#2F92EE;'>#高钾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102783, encryptionId=102f102e8375, topicName=高钾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5d010658633, createdName=ms7517674339485982, createdTime=Wed Dec 01 06:51:07 CST 2021, time=2021-12-01, status=1, ipAttribution=)]
    2021-12-01 ms3000001712111982

    学习了

    0

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