本文關鍵詞： 原發(fā)性醛固酮增多癥 醛固酮腺瘤 高鉀血癥　出處：《福建中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的和意義：原發(fā)性醛固酮增多癥(PA)是繼發(fā)性高血壓最常見的病因,腎上腺醛固酮腺瘤(APA)是原發(fā)性醛固酮增多癥的常見類型,腎上腺切除手術是腎上腺醛固酮腺瘤的主要治療方式,腎上腺切除手術可以導致術后短時間內醛固酮濃度低而出現(xiàn)術后高鉀血癥,本研究旨在明確腎上腺醛固酮腺瘤術后出現(xiàn)高鉀血癥的影響因素,從而盡可能的避免出現(xiàn)術后高鉀血癥,減少個人和社會的健康經(jīng)濟損失,另外,探討腎上腺醛固酮腺瘤切除手術對血壓、腎功能和電解質的影響,幫助臨床醫(yī)師謹慎的選擇治療方案。研究方法：本研究采取回顧性研究,通過閱讀國內外文獻明確腎上腺醛固酮腺瘤術后血鉀的可能影響因素,收集2009年1月—2015年7月于福建省立醫(yī)院符合納入標準的病例共119例,收集記錄研究需要的臨床資料,根據(jù)術后血鉀情況分成4組,對這4組的臨床資料運用統(tǒng)計學方法分析醛固酮腺瘤腎上腺切除術后血鉀的影響因素和明確腎上腺切除術對血壓、腎功能和電解質的影響。對計量資料符合正態(tài)分布的運用單因素方差分析,不符合正態(tài)分布的運用Kruskal-Wallis檢驗,對計數(shù)資料進行卡方檢驗,術前-術后臨床資料的比較運用配對t檢驗,所有統(tǒng)計學分析運用SPSS 20.0進行,P0.05有統(tǒng)計學意義。結果：(1)在119例單側腎上腺醛固酮腺瘤手術的病例中術后血鉀較高者(術后血鉀大于5.0mmol/l)有6例,占總體的5%,這6例的平均血鉀水平為5.38±0.38mmol/l;(2)將119例單側腎上腺醛固酮腺瘤的病例根據(jù)術后血鉀情況分為4組,將收集到的對術后血鉀有可能的影響因素進行單因素方差分析和Kruskal-Wallis檢驗分析,結合單因素方差分析和Kruskal-Wallis檢驗分析結果,進一步將對術后血鉀的可能影響因素進行有序多分類logistic回歸分析,得到年齡、術前醛固酮、術后血鈣、術后血磷、術后GFR和術后肌酐對術后血鉀的影響有統(tǒng)計學意義；(3)將術前-術后血壓、腎功能和電解質情況進行配對t檢驗,得到統(tǒng)計學結果表明通過腎上腺切除手術可以降低血壓,增加腎功能損害,可以升高血鉀、血磷,降低血鈉、血鈣。結論：影響單側醛固酮腺瘤術后血鉀的因素有年齡、術前醛固酮、術后血鈣、術后血磷、術后肌酐、術后GFR；單側醛固酮腺瘤經(jīng)過腎上腺切除手術治療可以降低血壓,短期內增加腎功能損害,可以升高血鉀、血磷,降低血鈉、血鈣。
[Abstract]:Objective and significance: primary aldosteronism (PAA) is the most common cause of secondary hypertension, and adrenal aldosterone adenoma (APA) is a common type of primary aldosteronism. Adrenalectomy is the main treatment for adrenal aldosterone adenoma. Adrenalectomy can lead to low aldosterone concentration and hyperkalemia in a short period of time. The aim of this study was to identify the influencing factors of hyperkalemia after adrenal aldosterone adenoma, so as to avoid hyperkalemia and reduce personal and social health and economic loss. To investigate the effect of aldosterone adenoma resection on blood pressure, renal function and electrolyte, and to help clinicians to choose the treatment plan carefully. By reading the literature at home and abroad to determine the possible influencing factors of serum potassium in patients with adrenal aldosterone adenoma, 119 cases were collected from January 2009 to July 2015 in Fujian Provincial Hospital to record the clinical data needed for the study. The clinical data of the four groups were divided into 4 groups according to the postoperative potassium status. The influence factors of serum potassium after adrenal resection of aldosterone adenoma and the blood pressure after adrenalectomy were analyzed by statistical method. Effects of renal function and electrolytes. Univariate ANOVA was used to measure the normal distribution, Kruskal-Wallis test was used to measure the normal distribution, chi-square test was performed on the counting data. Preoperative and postoperative clinical data were compared by paired t test. All statistical analyses were performed with SPSS 20.0 for P05. Results among 119 patients with unilateral adrenal aldosterone adenoma, 6 had higher serum potassium (K > 5.0 mmol / L). The average serum potassium level of these 6 patients was 5.38 鹵0.38 mmol / L ~ (2). 119 cases of unilateral adrenal aldosterone adenoma were divided into 4 groups according to the postoperative potassium status. The results of univariate ANOVA and Kruskal-Wallis test were combined with the results of univariate ANOVA and Kruskal-Wallis test. The possible factors influencing the postoperative serum potassium were further analyzed by logistic regression analysis in order to obtain age, preoperative aldosterone, postoperative serum calcium and postoperative phosphorus. The effect of postoperative GFR and postoperative creatinine on postoperative serum potassium was statistically significant (P < 0.05) the blood pressure, renal function and electrolytes were matched to t test before and after operation, and the results showed that the blood pressure could be lowered by adrenalectomy. Increase of renal function damage can increase blood potassium, blood phosphorus, decrease blood sodium, blood calcium. Conclusion: the factors affecting serum potassium after unilateral aldosterone adenoma are age, preoperation aldosterone, postoperative blood calcium, postoperative blood phosphorus, postoperative creatinine. Postoperative GFR: unilateral aldosterone adenoma can lower blood pressure, increase renal function damage, increase blood potassium, blood phosphorus, decrease blood sodium and calcium after adrenalectomy.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R699.3

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