缺氧对急性呼吸窘迫综合征患者消化道出血及肝功能的影响

The Effect of Anoxemia on Gastrointestinal Hemorrhage and Liver Function in ARDS Patients

目的探讨缺氧对急性呼吸窘迫综合征(ARDS)患者消化道出血及肝功能影响。方法 65例 ARDS 患者分为呼衰指数<100 mmHg(A 组)与呼衰指数100～200 mmHg(B 组)二组,比较消化道出血发生率、红细胞(RBC)、血红蛋白(HB)、及肝功能的变化。结果 ARDS 患者可发生消化道出血,其发生率为15.4%,A 组消化道出血率高于 B 组(P<0.05),且 A 组 RBC、HB 低于 B 组(P<0.05);非消化道出血 ARDS 患者中,A 组 RBC、HB 低于 B 组(P<0.01);A 组患者病前健康状况优于 B 组(P<0.05),但消化道出血发生率及 RBC、血红蛋白减少程度大于 B 组(P<0.05,P<0.01);A 组丙氨酸氨基转移酶(ALT)高于 B 组而血清总蛋白(TP)、血清白蛋白(Alb)低于 B 组(P<0.05)。结论①严重缺氧促发了 ARDS 患者 RBC、HB 减少及消化道出血的发生;缺氧越严重,RBC、HB 减少越明显,消化道出血发生率越高。②严重缺氧促发了 ARDS 患者 ALT 增高,TP、Alb 降低,并随缺氧加重而加重。

Objective To evaluate the effect of anoxemia on gastrointestinal hemorrhage and liver function in acute respiratory distress syndrome（ARDS） patients. Methods 65 cases of ARDS Patients were divided into two groups regarding to the respiratory failure index （RFI）. The patients whose RFI value were lower than 100mmHg were divided into A group, while the others whose RFI value were between 100 -200mmHg were divided into B group. The rate of gastrointestinal hemorrhage ,the change of erythrocyte ,hemoglobin ,white blood cell and liver function were evaluated. Results The rate of gastrointestinal hemorrhage in ARDS patients were 15.4% ,and the rate in A group was higher than that in B Group（ P 〈 0.05 ）. The erythrocyte count and hemoglobin in A group were lower than that in B group（ P 〈 0.05 ） . While in the patients without gastrointestinal hemorrhage, the erythrocyte count and hemoglobin in A group were lower than that in B group （ P 〈0.01 ） ;The condition of A group were better than that of B group（ P 〈0.05） ,but the rate of gastrointestinal hemorrhage and the decrease of erythrocyte and hemoglobin in A group were higher than that in B group（ P 〈 0.05, P 〈 0.01 ）. The value of ALT was higher in A group than that in B group, while the value of TP and ALB were lower than that in B group. Conclusion 1. Severe anoxemia promoted the gastrointestinal hemorrhage and the decrease of erythrocyte and hemoglobin, and more severe anoxemia, higher the rate of gastrointestinal hemorrhage and more serious the decrease of red cell and hemoglobin. 2. Severe anoxemia might contribute to the increase of ALT and the decrease of TP and Alb.