Solomon R J, Cole A G
Acta Med Scand Suppl. 1981;647:87-93. doi: 10.1111/j.0954-6820.1981.tb02643.x.
The records of 151 patients entering a coronary care unit and subsequently diagnosed as having an acute myocardial infarction were reviewed. The prevalence of hypokalemia, its relationship to diuretic treatment and the development of either ventricular tachycardia or ventricular fibrillation were studied. At admission, 14% of patients were hypokalemic. The presence of hypokalemia was related to previous diuretic therapy. Twenty-three percent of patients receiving diuretics as compared to 7% of patients not taking diuretics had a serum potassium of 3.5 mEq/L or less. Thirty-seven patients experienced either ventricular tachycardia or ventricular fibrillation. The presence of hypokalemia was associated with an increased frequency of both of these arrhythmias. Sixty-seven percent of patients with a serum potassium of less than 3.1 mEq/L had these serious ventricular arrhythmias compared to 40% of patients with a serum potassium between 3.1 and 3.5 mEq/L and 20% of normokalemic patients. The prevalence of premature ventricular beats was not correlated with the presence of hypokalemia. We conclude that hypokalemia is not only a common problem in patients with acute myocardial infarction but a clinically significant factor in the development of life threatening arrhythmias. Primary prevention of hypokalemia and its prompt treatment are indicated in these patients.
回顾了151名进入冠心病监护病房并随后被诊断为急性心肌梗死患者的记录。研究了低钾血症的患病率、其与利尿剂治疗的关系以及室性心动过速或心室颤动的发生情况。入院时，14%的患者存在低钾血症。低钾血症的存在与先前的利尿剂治疗有关。接受利尿剂治疗的患者中有23%血清钾浓度为3.5 mEq/L或更低，而未服用利尿剂的患者中这一比例为7%。37名患者发生了室性心动过速或心室颤动。低钾血症的存在与这两种心律失常的发生频率增加有关。血清钾浓度低于3.1 mEq/L的患者中有67%发生了这些严重的室性心律失常，而血清钾浓度在3.1至3.5 mEq/L之间的患者中这一比例为40%，血钾正常的患者中这一比例为20%。室性早搏的患病率与低钾血症的存在无关。我们得出结论，低钾血症不仅是急性心肌梗死患者中的常见问题，而且是危及生命的心律失常发生的一个具有临床意义的因素。这些患者需要低钾血症的一级预防及其及时治疗。
