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頁籤選單縮合
題名 | Intravenous Repletion of Phosphorus Deficiency in the Chronic Renal Failure Patients with Severe Hypophosphatemia=靜脈注射磷酸鈉溶液治療患有嚴重低血磷症之腎衰竭及尿毒症病人 |
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作者 | 張哲銘; 蔡哲嘉; 黃尚志; 陳鴻鈞; 顧進裕; 賴永勳; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 13:9 1997.09[民86.09] |
頁次 | 頁540-547 |
分類號 | 415.597 |
關鍵詞 | 靜脈注射; 重度低血磷症; Intravenous phosphate repletion; Severe hypophosphatemia; Uremia; |
語文 | 英文(English) |
中文摘要 | 嚴重低血磷症是一種有可能會危及生命的內科急症,尤其如果發生在本來就患有 其他嚴重病症的病人身上則更是如此,萬一是遇到腎臟衰竭病人的話,情形就更加複雜;本研究的目的在評估採用靜脈輸注磷酸鈉溶液來治療罹患嚴重低血磷症的慢性腎衰竭病人及九位已接受長期常規血液透析病人(七男八女,年齡42至83歲),因為不同原因而發現患有嚴重低血磷症 (< 1.2mg/dL),接受了經由中心靜脈輸注的磷質補充治療。本研究所用的製劑是由磷酸二氫鈉配製而來,其中含磷酸鹽13 mg/ml,鈉離子0.5 meq/ml,注射劑量是在每六至八小時內,經中心靜脈導管投予每公斤體重磷酸鹽2.5~3.0 mg.原本已經接受透析的病人仍舊按時接受透析治療。在治療過程當中,依病情需要測血液的鈉,鉀,鈣,磷以及副甲狀腺素濃度,一旦血液的磷濃度昇高到5.0~5.5mg/dL時就停止輸注治療。治療的結果發現全部十五位病人都安然度過嚴重低血磷症的病程期間,並且血磷濃度也都能達到預定數值,甚至我們發現雖然在達到血磷預定值後停止注射,大多數病人的血磷值會稍降低至正常值範圍內,所注射的磷鹽劑量從3438到9150mg不等,治療期間則從六到十七天。全部病人的整個治療過程之中,只發現到八次血液檢查有低血鈣 (<4.2mg/dL),但是都未曾引起臨床症狀。最後共有十一位病人痊愈,不過有四位病人不幸死亡。但是他們的死亡原因都和低血磷症沒有直接關係,而且時間上也都相隔二星期以上,我們的結論是採用這種較慢速度的靜脈輸注磷酸鈉溶液治療患有嚴重低血磷症之腎衰竭及尿毒症病人是安全而且有效的方法,較長的治療期間也使病人有充份時間調節體內平衡,注射進入體內的過多鈉離子可以用透析以及適當利尿劑來排除。 |
英文摘要 | Severe hypophosphatemla is a potentially life-threatening medical condition and might lead to a fatal outcome in critically ill patients. The situation Is further complicated by the co-morbid renal failure. We evaluated the efficacy and safety of the Intravenous phosphate repletion in 15 renaifailure patients with severe hypophosphatemla. Six patients with advaned renal failure and nine patients under maintenance hemodlalysis, 7 males and 8 females, aged between 42 and 83 years old, were found to have serum phosphate level < 1.2 mg/clL from various medical conditions and were treated with Intravenous phosphate Infusion. The phosphate solution prepared from sodium dihydrogen phosphate (NaH2PO4), containing 13 mg/mI phosphate and 0.5 meq/ml sodium, In the dosage 2.5-3.0 mg phosphate/Kg body weight, was administered through the central venous lins every 6-8 hours. The Infusion was discontluned once serum phosphate level reached 5.0-5.5 mg/dL. Serum ionized calcium, phosphate and intact parathyrold hormone levels were serially followed at different Intervals, respectively. The hemodialyzed uremic patients received their dialysis treatment as scheduled. All patients survived the hypophosphatemic period and regained normal phosphate levels after repletion. The amount of phosphate administered to reach the target level ranged between 3438 and 9150 mg and the duration of treatment varied between six and seventeen days. Hypocalcemia (<4.2 mg/dL) was noted at eight occasions during the whole treatment period but none was symptomatic. Eleven patients recovered from the offending Illness. However, four patients expired due to reasons not directly consequent to and temporally remote from hypophosphatemia. We conclude that prompt repletion of severe hypophosphatemia and phosphate deficiency with relatively slower rate of NaH2PO4 solution intravenous Infusion is a safe and effective mode of treatment for renal failure and uremic patients. The longer treatnient period allowed the administered minerals full equilibration. The risk of hyperkalemla is avoided and the sodium/volume load can be eliminated by dialysis. |
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