胃粘膜内pH值测定在危重病人中的预警价值

APPLICATION OF TONOMETRIC MEASUREMENT OF GASTRIC INTRAMUCOSAL pH IN CRITICALLY ILL PATIENTS

目的 :观察在危重病患者中反映组织水平氧代谢的胃粘膜内 p Hi,与反映全身氧代谢的指标间的关系以及胃粘膜内p Hi的预警价值。方法 :用胃张力计测定危重病患者入科即刻及治疗 2 4h后胃粘膜内 p Hi,并测定 p Ha ,Pa O2 / Fi O2 ,行 APACHE 评分。结果 :死亡组入科即刻 p Hi( 7.13 3± 0 .3 74)较存活组 ( 7.3 89± 0 .0 62 )显著降低 ( P<0 .0 1) ,治疗 2 4小时后胃粘膜内 p Hi死亡组( 6.911± 0 .496)较存活组 ( 7.43 4± 0 .0 5 1)降低更显著 ( P<0 .0 0 1) ;入科即刻 p Hi≤ 7.3 2的患者病死率为 75 .0 %,治疗 2 4h后胃粘膜内 p Hi≤ 7.3 2的患者病死率为 88.9%。结论 :作为局部组织氧合指标的 p Hi在常规的全身氧代谢指标未改变之前就发生了明显的变化 ;p Hi的降低与病死率有明显的相关性。

Objective: To investigate the relationship between gastric intramucosal pH which indicates tissue oxygen metabolism and conventional clinical indexes used to reflect systemic oxygen metabolism, and the value of pHi as a prognostric index of mortality in critically ill patients. Methods :When a tonometer was confirmed in the lumen of the stomach, PCO 2 in saline was measured together with arterial blood gases, the pHi in the gastric was calculated by Henderson-Hasselbalch equation. In this way ,the pHi immediately and 24 hours later were measured .Then acquired message to appraise APACHEⅡscore.Result :All patients were divided into two groups,one was survivor and the other was dead.There was no difference in Glasgow Coma Score (GCS score) ,pHa and PaO 2/FiO 2 between two groups . The pHi immediately in dead group (7.133±0.374) was lower than in survivor group(7.384±0.062),P<0.01. The pHi 24 hours later in dead group (6.911±0.496) was far lower than in survivor(7.434±0.051),P<0 001.When the pHi immediately was not more than 7.32,the mortality was 75%,When the pHi 24 hours later was not more than 7.32,the mortality increased to 88.9%.Conclusion:As a message of tissue hypoxia ,the pHi always alter earlier than the usual indicators,the pHi revelant to the mortality .It is a good prognostric index. [