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诱导性体温过低的电解质谱:一项评估心脏骤停后低体温持续时间的临床试验的子研究

2022-04-03 18:33

电解质大多保持在参考区间内。随着TTM的不同阶段,钾、镁和钙的浓度随时间而变化。

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诱导体温过低的电解质谱:一项评估心脏骤停后低体温持续时间的临床试验的子研究

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贵州医科大学  麻醉与心脏电生理课题组

翻译:马艳燕   编辑:张中伟   审校:曹莹

  01   背景

       患者电解质紊乱可能是由于院外心脏骤停(OHCA)靶向体温治疗(TTM)引起的。本研究探讨了接受TTM治疗的OHCA患者血液和尿液中的电解质变化。

  02   方法

       这是 TTH48 试验的一项子研究,纳入了 310 名在 33°C 下接受 TTM 治疗 24 或 48 小时的无意识 OHCA 患者。在三天的时间内,通过24小时的利尿和尿液电解质浓度和排泄量,获得钠、钾、氯化物、钙离子、镁和磷酸盐的血清浓度。通过重复测量的混合模型多变量方差分析来分析其随时间的变化。

  03   结果

       入院时,钠浓度为138±3.5 mmol/l(平均±SD),在前24小时内略有增加,差异具有统计学意义(p <0.05)。镁浓度维持在参考区间内。在前24小时内,钙离子浓度中位数从1.11mmol/l(IQR 1.1-1.2)上升(p <0.05),而磷酸盐中位数浓度降至1.02mmol/l(IQR 0.8-1.2)(p <0.05),并保持在较低水平。在复温过程中,钾浓度增加,镁和钙离子浓度降低(p <0.05)。第一天和第二天的24小时利尿结果中位数分别为2,198ml和2,048 ml,电解质排泄在参考区间内大多保持在较低水平。

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    0 4 结论

电解质大多保持在参考区间内。随着TTM的不同阶段,钾、镁和钙的浓度随时间而变化。没有发现低温对利尿的影响,而且尿液中的电解质排泄大多保持在低水平。

  0 5 原始文献来源

 Taccone FS, Skrifvars MB, Søreide E. Electrolyte profiles with induced hypothermia: a sub study of a clinical trial evaluating the duration of hypothermia after cardiac arrest. Acta Anaesthesiol Scand. 2022 Feb 26. 

英文原文    

Electrolyte profiles with induced hypothermia: a sub study of a clinical trial evaluating the duration of hypothermia after cardiac arrest

Background

Electrolyte disturbances can result from targeted temperature treatment (TTM) in out-of-hospital cardiac arrest (OHCA) patients. This study explores electrolyte changes in blood and urine in OHCA patients treated with TTM.

Methods

This is a sub-study of the TTH48 trial, with the inclusion of 310 unconscious OHCA patients treated with TTM at 33°C for 24 or 48 hours. Over a three-day period, serum concentrations were obtained on sodium potassium, chloride, ionized calcium, magnesium, and phosphate, as were results from a 24-hour diuresis and urine electrolyte concentration and excretion. Changes over time were analysed with a mixed-model multivariate analysis of variance with repeated measurements.

Results

On admission, mean ± SD sodium concentration was 138 ± 3.5 mmol/l, which increased slightly but significantly (p < 0.05) during the first 24 hours. Magnesium concentration stayed within the reference interval. Median ionised calcium concentration increased from 1.11 (IQR 1.1–1.2) mmol/l during the first 24 hours (p < 0.05), whereas median phosphate concentration dropped to 1.02 (IQR 0.8–1.2) mmol/l (p < 0.05) and stayed low. During rewarming, potassium concentrations increased, and magnesium and ionises calcium concentration decreased (p < 0.05). Median 24-hour diuresis results on days one and two were 2,198 and 2,048 ml respectively, and the electrolyte excretion mostly stayed low in the reference interval.

Conclusions

Electrolytes mostly remained within the reference interval. A temporal change occurred in potassium, magnesium and calcium concentrations with TTM’s different phases. No hypothermia effect on diuresis was detected, and urine excretion of electrolytes mostly stayed low.

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