CN105708791A - Method for treating severe hypokalemia through micro-pump injection of high-concentration potassium aspartate via central venous catherization - Google Patents

Abstract

The invention discloses a method for treating severe hypokalemia through micro-pump injection of high-concentration potassium aspartate via central venous catherization. Acute and severe patients received in emergency wards and ICU are normally accompanied by different electrolyte disturbances; severe hypokalemia a most common complication requiring timely treatment; and a conventional potassium supplementing method cannot achieve good curative effect due to restriction by some factors. Thus, the invention provides the method for treating severe hypokalemia through micro-pump injection of high-concentration potassium aspartate via central venous catherization according to concrete conditions, and the method produces satisfactory curative effect in clinical practice.

Description

Through the central vein catheter high concentration aspartic acid serious hypokalemia of micro pump injection for curing

Technical field

The invention discloses a kind of method through the central vein catheter high concentration aspartic acid serious hypokalemia of micro pump injection for curing, belong to field of pharmaceutical preparations.

Background technology

Correct the meaning of serious hypokalemia: blood potassium had both been serious hypokalemia lower than 2.5mmol/L, and room checks and changes can clarify a diagnosis with electrocardiogram relative specificity by experiment.The Clinical Manifestations of serious hypokalemia is cardiovascular symptom, the myocardial cell enzymatic activity that hypokalemia causes reduces or inactivation mitochondrial injury, calcium overload and intercellular lose the disperse that Rhizoma Nelumbinis joins, cause the electrical derangement of myocardial cell and asynchronous, the discrete increase of refractory stage and ventricle wall promote room to quiver generation across wall and compartment space multipole heterogeneity, also show as shock, heart failure；Neuromuscular symptom caused by low potassium, nervus centralis symptom can behave as collapse from physical exhaustion, paralysis of respiratory muscle and drowsiness stupor, wherein ventricular arrhythmia caused by low potassium and paralysis of respiratory muscle cause the main cause of Cardiac and respiratory arrest often.So actively kalium replenishment is mitigation symptoms and the key saving life effectively and rapidly.

Conventional and unconventional kalium replenishment: conventional intravenous potassium supplement method is to see urine kalium replenishment, speed can not be too fast, concentration is to be advisable less than 0.3%, dosage, no more than 1.0g/h, potassium chloride 3.0 ~ 6.0g/d, can use 6.0 ~ 10.0g on 1st, as can with quiet of 0.3% ~ 0.6% potassium chloride during because of potassium deficiency generation severe arrhythmia, paralysis of respiratory muscle, drip speed be 1.0 ~ 1.5g/h, must not with the 10% direct intravenous injection of potassium chloride, in order to avoid cause blood potassium suddenly give birth to cause sudden cardiac arrest.Break through the kalium replenishment forbidden zone less than 0.3%, concentration is brought up to 0.5% ~ 1.0% potassium chloride.And clinically, said method still can not meet the treatment needs of some critical patient.Method for compensating potassium in critical situation: (1) high concentration is quiet to be pushed away: push away with high concentration aspartic acid is slowly quiet.(2) heavy dose fills into: has in 10min and pushes 1.5g；Have in 1h, instill input aspartic acid 40g in 4g, 24h；Bigger person even reaches Intravenous Supplement aspartic acid 4.7g per hour, adds kalium replenishment in stomach tube, fills into 43g in 12h altogether.

Application through the central vein catheter high concentration aspartic acid serious hypokalemia of micro pump injection for curing: Cavity in Critical Patients has basis sick more, merge incomplete more of cardiac insufficiency, gastrointestinal function, orally kalium supplement or limited or slower, the restriction of fluid infusion total amount and speed make intravenous potassium supplement amount it cannot be guaranteed that, and apply this method.

Low concentration, jogging speed cannot function as the routine rescuing serious hypokalemia；Under tight monitor ECG, blood pressure and concentration of blood kalium, adopt suitable Aspartic Acid potassium concn and intravenous drip speed, this method is safely and effectively, the concentration of kalium replenishment should depending on the clinical symptoms of patient, underlying diseases, serum potassium specifically with the selection of dosage, accomplish the individuation of kalium replenishment, neither to ignore that sb.'s illness took a turn for the worse simply conventional kalium replenishment by rule；Body holding capacity can not be left out and pursue high concentration with heavy dose of, because low potassium is equally harmful to body with high potassium.This group method therefor kalium replenishment had both considered the individuation of low potassium patient, and application central vein catheter and micro pump eliminate the harm of moment height potassium again, it is to avoid too much liquid input, prevented peripheral vein stimulation pain and phlebitic appearance simultaneously.Method simple possible, clinic is promoted.

Summary of the invention

Feasibility: infusion amount cannot be controlled the level at constant speed trace by the intravenous drip in past and intravenous injection, moment hyperkalemia is caused in order to avoid the short time inputs too much potassium salt, so strictly to control the concentration of potassium in transfusion, and apply micro pump infusion, can ensureing that continued for constant trace injects, central vein blood volume is big, and high concentration aspartic acid is diluted rapidly after entering, avoid moment high potassium concentration to cause arrhythmia, and the potassium ion stimulation to blood vessel can be reduced.

Advantage: (1) is accurately controlled and grasps input speed and dosage, just with it is understood that patient's accurate response to aspartic acid input concentration Yu dosage, be conducive to timely adjustment.(2) avoiding a large amount of volume loads that conventional kalium replenishment brings, the big quantity of fluid that conventional kalium replenishment is brought into has not only increased the weight of heart and the kidney burden of patient, and the polyuria simultaneously occurred together even causes electrolyte disturbance, and some patients with heart failure itself are not resistant to conventional method for compensating potassium.And inject kalium replenishment through central vein catheter high concentration aspartic acid micro pump and will not cause kalium replenishment failure because of capacity reasons.(3) peripheral vein is replaced to avoid the stimulation to peripheral vein of the blood potassium with central vein catheter, it is prevented that pain, phlebitic appearance.

Points for attention: (1) notes pushing away with anti-error by the red eye-catching sign of board on micro pump.(2) every 2 ~ 4h monitors concentration of blood kalium once, carries out electrocardio hemodynamics, urine volume monitoring, in order to adjust in time simultaneously.(3) acid-base balance of blood and electrolyte monitoring.Sometimes hypokalemia and low magnesium, low sodium, hypochloraemia occur capacity and acid base imbalance even occur simultaneously, and this need to adopt comprehensive remedy measures processed.(4) avoid using a large amount of insulin and row's potassium diuretic in the process for filling potassium of serious hypokalemia in case potassium quickly in move and a large amount of lose ensureing that kalium replenishment effect prevents clinical symptoms deterioration significant.Unless there are serious acidosis, otherwise need not alkalescence medicine, it is prevented that pH change cause potassium in move.(5) because of extracellular potassium, to transfer in cell, slowly, intraor extracellular potassium balance about needs 15h, so the success of kalium replenishment should be and stops that potassium takes in more than 15h and substantially reducing of serum-free potassium is as the criterion.

Detailed description of the invention

Embodiment

The Acute critical diseases patient that emergency department, ICU accept for medical treatment diagnoses serious hypokalemia 36 example, male 21 examples, female 15 example, 18 ~ 92 years old age, average 63 years old.Wherein cerebrovascular disease sequela 12 example；Hypertensive cardiopathy, coronary heart disease left heart failure 7 example；Pulmonary heart disease respiratory failure, right heart failure 5 example；Severe cerebral injury 4 example；Complete intestinal obstruction 3 example；Chronic enteritis 2 example；Esophagus late tumor 2 example；Septic shock 1 example.Form the low potassium cause of disease clear and definite, companion's myasthenia in various degree, reflectance anomaly, concentration of blood kalium is below 2.5mmol/L, and minimum for 1.2mmol/L, electrocardiogram display T ripple is low flat two-way or is inverted, U ripple is obvious, there is serious ventricular arrhythmia in some cases, and severe one number secondary chamber is quivered and caused sudden cardiac arrest, and part accompanies low magnesium in various degree, low sodium, hypochloraemia.

Method: 1. eliminate on the basis of Cure the Primary Disease or avoid producing the reason of low potassium.2. all Central venous catherization is quickly carried out, it is to avoid the stimulation to blood vessel of the high potassium.3. overall potassium deficiency amount is estimated, 0.3mmol/L is often reduced by blood potassium, internal loss potassium amount 100mmol/L calculates, estimate to mend in 24 ~ 48h to more than 3.5mmol/L, 4. 3 kinds of speed class kalium replenishment: a. are divided lower than 1.5mmol/L or serious ventricular arrhythmia, serious paralysis of respiratory muscle person to occur for blood potassium depending on low potassium degree and complication situation, give aspartic acid 1.5g/h at the uniform velocity to pump into, after at the uniform velocity pump into 1.0g/h, 24h total amount is less than 30g.B. for blood potassium between 1.5mmol/L ~ 2.0mmol/L, and without serious ventricular arrhythmia, serious paralysis of respiratory muscle person, giving aspartic acid 1.0g/h and at the uniform velocity pump into, 24h total amount is less than 24g.C. for blood potassium between 2.0mmol/L ~ 2.5mmol/L, and without serious ventricular arrhythmia, serious paralysis of respiratory muscle person, giving aspartic acid 0.5g/h and at the uniform velocity pump into, 24h total amount is less than 12g.Can pump into or conventional intravenous potassium supplement is to normal range by 3 ~ 6g/24h when concentration of blood kalium rises to more than 3.0mmol/L.5. by aspartic acid stock solution 50mL suction syringe, pacify into micro pump, pump into above-mentioned speed threshold, hang warning sign therebetween and avoid pushing away by mistake, pump into speed when 1.0g/h ~ 1.5g/h, the monitoring concentration of blood kalium cycle is 2 ~ 4h, pumping into speed when 0.5g/h to 1.0g/h, the monitoring concentration of blood kalium cycle is 4 ~ 6h, records 24h urine volume, if 24h urine volume less than 500mL or per hour urine volume reduce to former speed 1/2 less than 30mL kalium replenishment speed, and shorten the monitoring concentration of blood kalium cycle.Regulate with monitoring concentration of blood kalium and pump into speed until during more than 3.5mmol/L, and in stopping that potassium takes in that more than 15h recurrence of disease at the same time next year has a blood test potassium concn and without being decreased obviously, clinical symptoms is improved, and is kalium replenishment success when electrocardiogram tends to normal.

Result

In 19 examples (52.8%) patient 48h, blood potassium rises to normally, and in 12 examples (33.3%) patient 72h, blood potassium rises to normally, and in 5 examples (13.9%) patient 96h, blood potassium rises to normally, hyperpotassemia phlebitis does not occur, does not also occur that arrhythmia and clinical symptoms increase the weight of.

Claims (5)

1. the kalium replenishment injection treating serious hypokalemia, it is characterised in that: active constituents of medicine is potassium salt, and adjuvant is water for injection.

2. the kalium replenishment injection of the serious hypokalemia for the treatment of according to claim 1, it is characterised in that serious hypokalemia can be treated.

3. the kalium replenishment injection of the serious hypokalemia for the treatment of according to claim 1, it is characterised in that described potassium salt includes potassium salt.

4. potassium salt according to claim 3 is aspartic acid.

5. the kalium replenishment injection of the serious hypokalemia for the treatment of according to claim 1, it is characterised in that described water for injection is normal saline or G/W.