- 期刊
Glucose-Insulin Infusion for the Early Treatment of Non-Oliguric Hyperkalemia in Extremely-Low-Birth-Weight Infants
以葡萄糖—胰島素輸液早期治療超低出生體重兒非寡尿性高血鉀症
摘要
為了研究超低出生體重兒非寡尿性高血鉀症之情況及並發症和評估胰島紗輸注的治療結果，161位出生體生小於1000公克之早產兒作分析。本研究以血鉀濃度超過6mEq/L視為高血鉀並以葡萄糖—胰島素溶液開始治療，血鉀連續6小時在小於6mEq/L後停止治療，他們被分為兩組：高血鉀症組及非高血鉀症組。超低出生體重兒高血鉀症發生率為58%(93/161)，平均懷孕週數在高血鉀組及非高血鉀組分別為25.7±1.8週及其26.62±1.7週，平均出生體重為770±145克及811±124克；高血鉀組診斷為高血鉀的時間在出生後17.0±8.9小時，兩組的平均血鉀上升的速度分別為每小時小升0.32±0.29mEq/L及0.13±0.12mEq/L；嚴重腦室出血的發生率是19%(18/93)及4.4%(3/68)，心律不整的發生率是12%(11/93)及0%，均具統計意義。所以懷孕週數愈短，血鉀濃度上升愈快的病人更可能發生高血鉀症，高血鉀明顯會增加嚴重腦室出血及心律不整的危險性。在使用胰島素後，要保持較高的葡萄糖輸注速率，以免造
並列摘要
In order to investigate the status of non-oliguric hyperkalemia and to evaluate glucose-insulin infusion treatment among extremely-low-birth-weight (ELBW) infants, 161 infants weighting less than 1000gm at birth were enrolled for this study. They were divided into two groups: a hyperkalemic group and a non-hyperkalemic group. Hyperkalemia was defined here as a serum potassium level of greater than 6mEq/L in a non-hemolyzed arterial blood sample. A glucose-insulin infusion was administered to the patients when hyperkalemia was detected in them during the first few days after birth. The infusion was discontinued when the serum potassium levels had been less than 6mEq/L and stabilized for 6 hours. The incidence of non-oliguric hyperkalemia among ELBW infants in this study was 58% (93/161). The mean gestational age of neonates was 25.7±1.8 weeks (hyperkalemic) and 26.6±1.7 weeks (non-hyperkalemic). The mean rate of increases in serum potassium levels was 0.32±0.29mEq/L/hr (hyperkalemic) and 0.13±0.12mEq/L/hr (non-hyperkalemic). The incidence of severe intraventricular hemorrhage (IVH) was 19% (18/93) (hyperkalemic) and 4.4% (3/68) (non-hyperkalemic). The incidence of cardiac arrhythmia was 12% (11/93) (hyperkalemic) and 0% (non-hyperkalemic) respectively. Neonates with fewer weeks of gestation at birth and faster increases in serum potassium levels were associated with a more prominent tendency toward hyperkalemia. Hyperkalemia markedly increases the risk of severe IVH and arrhythmia for ELBW infants. A higher glucose infusion rate should be maintained to prevent hypoglycemia following insulin treatment.