临床中肝硬化患者胃肠道状态与血氨水平的相关性

Relationship between blood ammonia levels and gastrointestinal condition in patients with cirrhosis

目的:探讨临床中肝硬化患者胃肠道状态与血氨水平的相关性,为临床中减少肠道氨吸收和降低血氨提供治疗依据.方法:选取2011-01/2012-12我院收治的单纯性肝硬化、肝硬化伴消化系出血、肝硬化伴便秘、单纯性肠梗阻、单纯性消化系出血患者为研究对象.正常健康者为对照,分析各组中血氨的变化以及肝硬化伴胃肠道障碍治疗前后的血氨变化.结果:单纯性肝硬化患者血氨水平均明显的高于单纯性消化系出血、单纯性肠梗阻和正常对象血氨水平(t=6.251,t=6.802,t=7.328,P<0.05);肝硬化伴消化系出血患者血氨水平均明显高于单纯性消化系出血、单纯性肠梗阻和正常对象血氨水平(t=5.152,t=5.738,t=6.173,P<0.05);肝硬化伴便秘患者血氨水平明显高于单纯性消化系出血、单纯性肠梗阻和正常对象血氨水平(t=8.402,t=8.477,t=9.132,P<0.05);且肝硬化伴消化系出血、肝硬化伴便秘患者血氨水平明显高于单纯性肝硬化血氨水平(t=7.241,t=11.374,P<0.05).42例肝硬化伴消化系出血和便秘患者酸化肠道及输血治疗前血氨为85.3μmol/L±33.7μmol/L,治疗后血氨为51.4μmol/L±18.5μmol/L,42例肝硬化伴消化系出血和便秘患者酸化肠道及输血治疗后患者血氨水平明显的低于治疗前(t=21.402,P<0.05).结论:临床中肝硬化患者胃肠道状态与血氨水平具有紧密的联系,肝硬化伴肠道障碍患者血氨明显的升高,加强肝硬化伴肠道障碍的酸化肠道及合理用血治疗能够有效降低血氨水平,预防肝性脑病的发生.

AIM： To investigate the relationship between gastrointestinal condition and blood ammonia levels in cirrhotic patients to provide a basis for reducing the intestinal absorption of ammonia and lowering blood ammonia in the clinical setting. METHODS： Patients with simple cirrhosis, cirrhosis with gastrointestinal bleeding, liver cirrhosis with constipation, simple intestinal obstruction, or simple gastrointestinal bleeding treated at our hospital from January 2011 to December 2012 were studied. Healthy subjects were also included as controls. The changes in ammonia in each group, and ammonia changes in cirrhotic patients with gastrointestinal disorders before and after treatment were compared. RESULTS： Blood ammonia was significantly higher in patients with simple cirrhosis than inthose with simple gastrointestinal bleeding or intestinal obstruction and normal subjects（t = 6.251, 6.802, 7.328, P〈0.05）, in cirrhotic patients with gastrointestinal bleeding than in those with simple gastrointestinal bleeding or simple intestinal obstruction and normal subjects（t = 5.152, 5.738, 6.173, P〈0.05）, in cirrhotic patients with constipation than in those with simple gastrointestinal bleeding or simple intestinal obstruction and normal objects（t = 8.402, 8.477, 9.132, P〈0.05）, and in cirrhotic patients with gastrointestinal bleeding or constipation than in those with simple cirrhosis（t = 7.241, 11.374, P〈0.05）. In 42 cirrhotic patients with gastrointestinal bleeding or constipation, blood ammonia levels after acidification treatment were significantly lower than those before treatment（51.4 μmol/L ± 18.5 μmol/L vs 85.3 μmol/L ± 33.7 μmol/L, t = 21.402, P〈0.05）. CONCLUSION： The gastrointestinal condition has a close relationship with blood ammonia levels in patients with cirrhosis. Cirrhotic patients with intestinal disorders have significantly increased blood ammonia levels. Acidification treatment can effectively reduce intestinal ammonia levels and prevent hepatic encephalopathy.