目的探讨血管紧张素转化酶抑制剂(ACEI)及血管紧张素受体拮抗剂(ARB)对血液透析患者血钾的影响.方法选取血液透析超过3个月的尿毒症合并高血压患者共106例,先将收缩压>180mmHg或舒张压>100mmHg以及原先使用ACEI或ARB的患者直接纳入治疗组,其余再按照随机数字表法将对应的透析病历号按1：2分为两组,治疗组47例,对照组59例.在透析前、1、2、3个月检测血钾1次.结果治疗组血钾在透析前、1、2、3个月的检测结果为(4.640±0.640)、(5.160±0.895)、(5.220±0.980)、(5.160±0.990)mmol/L,而对照组血钾分别为(4.660±0.838)、(4.970±0.828)、(4.880±0.752)、(4.660±0.804)mmol/L.两组比较差异有统计学意义(P<0.05).对治疗组患者作自身对照研究发现,使用ACEI或ARB第1、2、3个月的血钾与透析前进行比较,差异均有统计学意义(均P<0.05).在治疗过程中,血钾>5.5mmol/L治疗组发生35例次,占24.8%,对照组发生18例次,占10.2%,两组间差异有统计学意义(P<0.05).结论在血液透析患者中使用ACEI或ARB时要慎重；如果使用ACEI或ARB,要严格控制患者饮食中钾的摄入以及加强血钾的检测,防止高钾血症的发生.%Objective To investigate the effect of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin re-ceptor blockers (ARB) on serum potassium levels in hemodialysis patients. Methods One hundred and six patients with uremia and hypertension, who underwent hemodialysis for more than three months, were divided into treatment (n=47) and control (n=59) groups, patients in treatment group received ACEI or ARB. Serum potassium levels were detected at 0, 1, 2 and 3 months after treatment. Results Serum potassium levels of patients in treatment group at 0, 1, 2 and 3 months after treatment were (4.640 ± 0.640)mmol/L, (5.160 ± 0.895)mmol/L,(5.220 ± 0.980)mmol/L and (5.160 ± 0.990)mmol/L, respectively;while those of patients in control group were (4.660±0.838)mmol/L, (4.970±0.828)mmol/L, (4.880±0.752)mmol/L and (4.660±0.804)mmol/L, respec-tively, there were significant differences between two groups (P<0.05). In self-control ed study of treatment group the serum potassium levels at 1, 2, 3 months after treatment were significantly higher than those before treatment (P<0.05). Thirty five cases had serum potassium levels>5.5mmol/L after 3 months of treatment accounting for 24.8%in treatment group, while 18 cases in control group accounting for 10.2%(P<0.05). Conclusion Hemodialysis patients treated with ACEI or ARB should strictly control potassium intake and frequently examine serum potassium levels to prevent hyperkalemia.
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