血钾水平与心脏骤停患者接受ECMO治疗后48 h院内死亡的关联-现代医学

血钾水平与心脏骤停患者接受ECMO治疗后48 h院内死亡的关联

单位：1. 徐州医科大学附属淮安医院检验科, 江苏淮安 223002;
2. 淮安市第三人民医院检验科, 江苏淮安 223021;
3. 南京医科大学附属淮安第一医院检验科, 江苏淮安 223300

分类号：R541.78;R459.6

出版年·卷·期（页码）：2026·54·第五期（808-816）

摘要：

目的：分析血钾水平与心脏骤停(CA)患者接受体外膜肺氧合(ECMO)治疗后48 h院内死亡的关联，并通过亚组分析探讨高危人群。方法：采用回顾性队列研究设计，连续纳入2018年3月至2025年5月于徐州医科大学附属淮安医院和南京医科大学附属淮安第一医院接受ECMO治疗的216例院内心脏骤停(IHCA)患者。采用多重插补法处理缺失数据，通过单因素、多因素Logistic回归分析筛选48 h院内死亡的独立危险因素，通过高血压、糖尿病、性别亚组分析进一步识别高危人群，采用方差膨胀因子和容忍度进行变量共线性诊断，敏感性分析验证数据插补的可靠性。结果：高钾组(>4.5 mmol·L^-1)48 h院内死亡风险显著高于正常组(4.0~4.5 mmol·L^-1)，高血钾水平是CA患者48 h院内死亡的独立危险因素(OR=3.093，95%CI 1.114~8.955，P=0.033)；亚组分析显示，男性亚组中血钾水平高的患者48 h院内死亡风险显著升高(OR=3.915，95%CI 1.109~15.040，P=0.038)，而高血压、糖尿病亚组中血钾各分级与48 h院内死亡的关联无统计学意义(均P>0.05)；共线性诊断显示，所有纳入模型的变量方差膨胀因子均<2，容忍度均>0.7，无明显共线性；敏感性分析显示，数据插补前后各指标分布差异均无统计学意义(均P>0.05)，结果稳定。结论：接受 ECMO治疗的CA患者中，血清血钾水平升高与48 h院内死亡风险增加相关，临床通过监测和及时干预血钾水平有望改善ECMO治疗的CA患者预后。

Objective: To analyze the association between serum potassium level and 48 h in-hospital mortality in cardiac arrest patients treated with extracorporeal membrane oxygenation(ECMO), and to identify high-risk populations through subgroup analysis. Methods: This retrospective cohort study enrolled 216 patients with in-hospital cardiac arrest who received ECMO treatment at The Affiliated Huai'an Hospital of Xuzhou Medical University and The Affiliated Huai'an First People's Hospital of Nanjing Medical University from March 2018 to May 2025. Missing data were handled by multiple imputation. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for 48 h in-hospital mortality. Subgroup analyses were conducted according to hypertension, diabetes, and sex to further identify high-risk populations. Variance inflation factor and tolerance were used to assess collinearity, and sensitivity analysis was performed to evaluate the stability of the imputed data.Results:The risk of 48 hin-hospital mortalitywas significantly higher in the high-potassium group(>4.5 mmol·L^-1) than in the normal group(4.0-4.5 mmol·L^-1). Elevated serum potassium was an independent risk factor for 48 h in-hospital mortality in cardiac arrest patients(OR=3.093,95%CI 1.114-8.955,P=0.033). Subgroup analysis showed that higher serum potassium was significantly associated with increased in-hospital mortality in male patients(OR=3.915,95%CI 1.109-15.040,P=0.038). However, no significant association was found between potassium categories and 48 h in-hospital mortality in the hypertension or diabetes subgroups(all P>0.05). Collinearity analysis showed that the variance inflation factor for all variables was<2 and the tolerance was>0.7, indicating no obvious collinearity. Sensitivity analysis showed no significant differences in variable distributions before and after multiple imputation(all P>0.05), suggesting that the results were stable. Conclusion: Elevated serum potassium is associated with increased risk of 48 h in-hospital mortality in cardiac arrest patients treated with ECMO, especially in male patients.

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