成人肝移植术后发生低钾血症的危险因素探讨

目的 探讨成人患者肝移植手术后低钾血症的发生率及其围手术期的危险因素。方法 回顾性分析行肝移植手术的97例患者术后发生低钾血症的发生率，同时对患者低钾血症可能相关的术前、术中及术后共34个因素进行多因素logistic回归分析，并用ROC曲线对回归模型进行检验。结果 肝移植术后低钾血症发生率为40.2％；男性、年龄（Age＞55岁）、手术时间（＞420min）及术后碳酸氢根离子浓度（>26mmol/L）为发生术后低钾血症的4个独立危险因素。ROC检验曲线的AUC为0.82±0.05（P<0.01）结论 肝移植术后低钾血症的发生率高，而男性、年龄（Age＞55岁）、手术时间（＞420min）及术后碳酸氢根离子浓度（>26mmol/L）者更易于发生术后低钾血症，缩短手术时间、恰当使用碳酸氢盐是降低低钾血症发生率的关键。

Investigation on risk factors of hypokalemia in adult patients after liver transplantation

Objective To investigate the incident rate of hypokalemia in adult patients after liver transplantation(LT) and the related risk factors peri-operation. Methods The incident rate of hypokalemia of 97 patients underwent LT were calculated. And 34 possible hypokalemia-related factors peri-operation were analyzed with multivariate logistic regression. And ROC was used to test the fitness of the regression model. Results The incident rate of hypokalemia was 40.2%. Male, age(above 55 yr), operation duration time (>420 min) and post-operation concentration of bicarbonate ion (>26mmol/L) were independent risks factors of hypokalemia after LT, and the OR were 6.78 and 4.97(both P<0.01) respectively. And the AUC of the regression model was 0.82±0.05（P<0.01）in the ROC. Conclusion The incident rate of hypokalemia after LT was high. Patient who with the characteristic of Male, age(above 55 yr), operation duration time (>420 min) and post-operation concentration of bicarbonate ion (>26mmol/L) is vulnerable to hypokalemia after LT. Reducing the Operation duration time and adequately using of bicarbonate fluid are key measures to reduce the incident rate of hypokalemia.