肝性脑病酸碱平衡紊乱与预后关系的研究

Study on the relationship between hepatic encephalopathy acid-base balance disorders and prognosis

目的 提高对肝性脑病 (HE)发生酸碱平衡紊乱的认识及其与预后的关系。方法 用微量血气分析仪测定动脉血气参数 ,用同一标本测定血氨 (NH3 ) ,用静脉血同步测定血钾 (K+ )、血钠 (Na+ )、血氯 (Cl-)和血尿素氮 (BUN)、血肌酐(Cr)。血气参数按各型酸碱失衡预计代偿公式计算 ,同时计算阴离子隙 (AG)值和潜在碳酸氢根 (HCO-3 )。结果 196例HE中单纯性酸碱平衡紊乱者 6 0例 ,死亡 33例 (5 5 0 % ) ,混合型酸碱平衡紊乱者 136例 ,死亡 111例 (81 6 % ) (P <0 0 1) ;pH <7 30者 2 1例 ,死亡 2 0例 (95 2 % ) ,pH >7 30者 175例 ,死亡 12 4例 (70 9% ) ;PaCO2 ≤ 4 7kPa者 174例 ,死亡 12 9例 (74 1% ) ,PaCO2≥ 6 0kPa者 6例均死亡 ;PaO2 ≤ 10 7kPa者 134例 ,死亡 114例 (85 1% ) ;HCO-3 ≤ 2 2 0mmol/L者 143例 ,死亡 10 8例 (75 5 % ) ,HCO-3 ≥ 2 7 0mmol/L者 19例 ,死亡 16例 (84 2 % )。 196例中死亡 144例 ,病死率为 73 5 %。结论 HE患者并发酸碱平衡紊乱时病死率颇高 ,pH值是影响HE预后的重要因素 ,PaCO2 、PaO2 和HCO-值对HE预后的影响较小。在救治时 ,积极治疗原发病的同时 ,动态监测动脉血气分析 ,尽早发现并及时纠正酸碱平衡紊乱 ,提高HE的救治水平。

Objective To study the significance of the occurrence and the development of acid-base balance disorders in patients with hepatic encephalopathy (HE) and its relationship with prognosis.Methods The perameter of arterial blood was determined with a microanalyser; NH 3 was determined with the same sample K +、Na +、Cl -、BUN and Cr were determined with vein blood at the same time. The blood perameter was calculated according to the compensatory formula of acid-base disturbance (ABD); the value anion gap(AG) and potential bicarbonate (HCO - 3) were calculated at the same time.Results In the 196 cases with HE, 60 patients developed pare acid-base balance disorers, 33(55.0%) of whom died; 136 patients developed complex acid-base balance disorders, 111 (81.6%) of whom died (P<0.01); 20(95.2%) of 21 patients with pH≤7.30 died; 124 (70.9%) of 175 patients with pH≥7.30 died; 129 (74.1%) of 174 patients with PaCO 2≤4.7 kPa died; 6 patients with PaCO 2≥6.0 kPa all died; 114 (85.1%) of 134 patients with PaO 2≤10.7 kPa died; 108(75.5%) of 143 patients with HCO - 3≤22.0 mmol/L died; 16(84.2%) of 19 patients with HCO - 3≥27.0 mmol/L died. 144 of the 196 patients investigated died. The mortality rate was 73.5%.Conclusions It is suggested that the mortality rate of the patients is rather high when the patients with HE develop complication of acid-base balance disorders; the value of pH is an important factor affecting HE prognosis; the values of PaCO 2、PaO 2 and HCO 3 - have relatively less influence on HE prognosis. While actively treating primary diseases, it is important to monitor dynamically the analysis of arterial blood, discover and correcting acid-base balance disorders as early as possible so as to enhance the curing level of HE. [