透析液中的鉀離子濃度到底要多少才好?這幾年的研究,也是在慢慢的修正觀念,2001年的研究說,使用鉀離子濃度為0或1.0 mEq/L之透析液者,析中發生心臟停止的機會增加為兩倍。2011年的研究確認,使用2.0 mEq/L以上的透析液,不管析前血鉀濃度多少,都比較安全,如下圖示。2012年的研究,甚至顯示使用 3.0 mEq/L以上的透析液,最不容易引起心臟病猝死。
圖中一直到了血鉀濃度大於 6.5 mEq/L以上,才看到“似乎”有翻盤的局勢,但是這樣的差距仍然太小,統計上是沒有差異的,因此結論是:透析液的鉀離子濃度使用 2.0 mEq/L以上,安全性完勝!
理想中最安全的做法,就是讓透析液與血中的鉀離子濃度差距,全程維持一定( 2 mEq/L以內)的差距,這種方式叫做“鉀離子濃度梯度”,研究指出這個方式,移除體內鉀離子的速度,與傳統方式差不多,又能使得血中鉀離子不會一下子降的太低,而增加安全性,只可惜這種方式,存在於不計代價的理想當中,而現實世界中目前沒有辦法普及。
其他會影響透析時鉀離子變化的因子,有透析液的葡萄糖濃度(刺激胰島素,使得血中鉀離子跑進細胞裡面,而使得透析第一個小時的鉀離子濃度下降的更快),透析液的過度鹼性(一樣使得鉀離子躲進細胞內,導致一樣的結果)。
重點整理:
1. 透析液的鉀離子濃度,最好使用 2.0 mEq/L以上,主要是為了避免透析後期(或者剛透析完的那幾個小時),腎友變成低血鉀,而導致心律不整,進而產生危險的心臟病猝死。
2. 如果腎友的透析前血中鉀離子濃度是正常偏低,一定不能用低於 2.0 mEq/L的透析液,不然透析後的低血鉀,會造成危險。
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