肝硬化合并肝性脑病患者脑氧利用率的临床研究

Changes of cerebral oxygen utilization coefficients in hepatic cirrhosis patients complicated with hepati cencephalopathy

目的探讨肝硬化合并肝性脑病患者脑氧利用率（O2UCc）与病情预后的关系。方法选择2012年6月至2013年8月在浙江中医药大学附属杭州西溪医院住院的肝硬化合并肝性脑病患者40例作为观察组，并随机选择同期住院肝硬化无肝性脑病患者40例作为对照组，通过颈内动脉和颈内静脉采血，检测颈内动脉血氧饱和度（SaO2）、颈内静脉血氧饱和度（SjO2）；根据氧利用率的计算公式推导出O2UCc=S（a-j）O2／SaO2；分析O2UCc与肝性脑病病情及预后的关系。结果观察组SjO2〉75％的患者有38例（95．0％）。观察组Sj02高于对照组【（86．22±6．34）％：（65．74±5．92）％】，而O2UCc低于对照组【（13．13±4．84）％：（32．72±6．67）】，差异均有统计学意义（t=16．57，P〈0．05；t=26．76，P〈0．01）。观察组中10例死亡患者与30例生存患者Sa02比较差异无统计学意义（黔0．05），SjO2高于生存患者[（91．26±2．11）％：（82．25±6．17）％】，O2UCc均〈9．50％，低于生存患者【（7．57±2．01）％：（15．76±5．04）％】，且差异均有统计学意义（t=12．69、28．64，P〈0．05）。结论肝性脑病患者常伴脑氧代谢动力学障碍，以高SjO2和低O2UCc为主要表现，O2UCc〈9．5％可能提示预后不良。

Objective To study the relationship between cerebral oxygen utilization coefficients （O2UCc） in hepatic cirrhosis patients with hepatic encephalopathy （HE） and prognosis. Methods Case group included 40 hepatic cirrhosis patients accompanied by HE who were treated in Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University from June 2012 to August 2013, and control group included 40 hepatic cirrhosis patients without HE treated in the same hospital during the same period. The changes in oxygen saturation of carotid blood （SaO2） and oxygen saturation of jugular blood （SjO2） were detected by blood gas analysis, and then O2UCc was calculated [O2UCc= S （a-j）O2/SaO2]. The relationship of the patients＇ condition and prognosis was analyzed. Results Thirty-eight patients with SjO2 higher than 75% accounted for 95.0% in cases group. SjO2 was significantly higher and 02UCc was significantly lower in case group than those in control group[（86.22±6.34）% vs （65.74±5.92）%, t=16.57, P〈0.05 ;（13.13±4.84）% vs （32.72±6.67）%, t=26.76, P〈0.01]. In case group, no significant difference in SaO2 was noted between 10 dead cases and 30 alive patients （P〉0.05）; Sj02 was significantly higher and 02UCc was obviously lower in dead patients compared with those in alive ones [（91.26±2.11）% vs （82.25±6.17）%, （7.57±2.01）% vs （15.76±5.04）%, t=12.69, 28.64, P〈0.05]; O2UCc were all lower than 9.5% in 10 dead cases. Conclusions Patients with hepatic encephalopathy often encounter with obstacles in the dynamics of cerebral oxidative metabolism, the main manifestation of which are high SjO2 and low O2UCc. O2UCc lower than 9.5% may suggest a bad prognosis.