肝硬变患者血氧变化临床分析及其机制探讨

Hypoxemia and its pathogenesis in patients with liver cirrhosis

目的探讨肝硬变患者血氧变化及其发生机制．方法肝硬变患者６６例，应用血气分析仪测定其动脉血氧分压（ＰａＯ２）及氧饱和度（ＳａＯ２），其中肝炎后肝硬变６２例，酒精性肝硬变１例，血吸虫性肝硬变１例，原因不明肝硬变２例，肝功能ＣｈｉｌｄＡ级８例，Ｂ级３５例，Ｃ级２３例．选择同期１４例正常人作对照．结果肝硬变组平均ＰａＯ２为１１１３ｋＰａ±０１９ｋＰａ，ＳａＯ２为９７２２％±０１５％，正常对照组动脉血ＰａＯ２为１３１３ｋＰａ±０３６ｋＰａ，ＳａＯ２为９８０７％±０２５％，两者比较差异明显（Ｐ＜００１）．肝硬变患者ＰａＯ２，ＳａＯ２降低与门静脉内径，蜘蛛痣有关，与肝功能Ｃｈｉｌｄ分级，ＡＬＴ，胆碱酯酶无关，也与胸腔积液无关．结论肝硬变存在低氧血症，发生主要在于肺内血管扩张．

AIM To explore the incidence of hypoxemia and its pathogenesis in liver cirrhosis. METHODS The partial pressure of oxygen (PaO 2) and oxygen saturation of arterial blood (SaO 2) in 66 liver cirrhosis patients were examined by automatic blood gas analyser (ABL 3 type, Denmark). Of them, 62 were posthepatitic cirrhosis, 1 schistosomial cirrhosis, 1 alcoholic cirrhosis and 2 idiopathic. At the same time, 14 healthy volunteers were studied as controls. RESULTS The PaO 2 and SaO 2 in patients with liver cirrhosis were 11 13kPa ± 0 19kPa and 97 22%±0 15%. The PaO 2 and SaO 2 in the normal were 13 13kPa ± 0 16kPa and 98 07%±0 25%. The difference was significant ( P <0 01). And the low PaO 2 and SaO 2 were related to inner diameter of the portal vein and vascular spider. But they were not related to liver function status, serum concentration of ALT, cholinesterase and pleural effusion. CONCLUSION Hypoxemia in patients with liver cirrhosis is related with vascular dilation in the lungs.