Solomon R J
Drugs. 1986;31 Suppl 4:112-20. doi: 10.2165/00003495-198600314-00014.
An association between low serum potassium concentrations and ventricular arrhythmias has been observed by a number of investigators in patients with both acute myocardial infarction and symptomatic angina. The increased frequency of ventricular fibrillation in patients with low serum potassium concentrations has not been attributable to differences in the size or location of the infarct or concomitant digitalis administration. Although prior diuretic usage is frequently associated with a low serum potassium concentration, diuretic usage in the absence of significant changes in serum electrolytes is not associated with an increase in malignant ventricular arrhythmias. It is not clear whether the alterations in serum potassium are important in the pathogenesis of the arrhythmias or merely a marker for other arrhythmogenic factors. To the extent that changes in serum potassium contribute to the production of serious ventricular arrhythmias, efforts should be directed at the correction of such electrolyte disturbances. Attempts to increase the serum potassium in acute cases do not appear to be successful in preventing ventricular arrhythmias in this setting. Primary prevention of electrolyte disturbances would seem to offer more effective protection against serious arrhythmias. Long term studies with beta-blockers support this premise.
许多研究人员在急性心肌梗死和有症状性心绞痛患者中观察到血清钾浓度低与室性心律失常之间存在关联。血清钾浓度低的患者室颤频率增加并非归因于梗死面积或部位的差异，也不是由于同时使用洋地黄。虽然先前使用利尿剂常与血清钾浓度低有关，但在血清电解质无显著变化的情况下使用利尿剂与恶性室性心律失常增加无关。尚不清楚血清钾的改变在心律失常的发病机制中是否重要，或者仅仅是其他致心律失常因素的一个标志。就血清钾变化导致严重室性心律失常而言，应致力于纠正此类电解质紊乱。在这种情况下，试图在急性病例中提高血清钾浓度似乎无法成功预防室性心律失常。对电解质紊乱进行一级预防似乎能更有效地预防严重心律失常。对β受体阻滞剂的长期研究支持这一前提。
