Chen C H, Hong C L, Kau Y C, Lee H L, Chen C K, Shyr M H
Department of Anesthesia, Chang Gung Memorial Hospital, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1999 Sep;37(3):163-6.
We report a girl who developed severe and fatal hyperkalemia following rapid and massive blood transfusion during surgery. She was 7-year-old, 20-kg in weight, and received wide resection of the femoral bone with custom prosthesis implant because of malignant femoral osteosarcoma. During the procedure, bleeding was active and profuse and amounted to about 3,000 mL in 4 h, eventuating in shock. Despite rapid transfusion with 15 units of packed red blood cells (RBC) still she remained hypotensive and hypovolemic. When we switched to give her whole blood, actually 100 mL having been given, widening of QRS complex followed immediately by cardiac arrest developed. Cardiopulmonary resuscitation although started at once was unsuccessful. At this juncture, arterial blood gas analysis showed acidosis and severe hyperkalemia (10.3 mmol/L), possibly resulting from transfusion of blood of older storage. The case reminded us once again the importance and necessity of the use of potassium-low blood component (fresh, saline-washed RBCs) in case of massive and rapid blood transfusion especially in pediatric patients with hypovolemia and low cardiac output.
我们报告了一名女孩，她在手术期间快速大量输血后发生了严重且致命的高钾血症。她7岁，体重20公斤，因恶性股骨骨肉瘤接受了定制假体植入的股骨广泛切除术。手术过程中，出血活跃且大量，4小时内出血量约达3000毫升，最终导致休克。尽管快速输注了15单位的浓缩红细胞（RBC），但她仍处于低血压和低血容量状态。当我们改为给她输注全血时，实际上只输注了100毫升，随即出现QRS波群增宽，随后发生心脏骤停。尽管立即开始了心肺复苏，但未成功。此时，动脉血气分析显示酸中毒和严重高钾血症（10.3毫摩尔/升），这可能是由于输注了储存时间较长的血液所致。该病例再次提醒我们，在大量快速输血的情况下，尤其是对于低血容量和低心输出量的儿科患者，使用低钾血液成分（新鲜的、生理盐水洗涤的RBC）的重要性和必要性。
