摘要
[目的]探讨急性上消化道出血患者出血量估算中血尿素氮(BUN)肌酐(Cr)变化曲线的应用及其临床价值。[方法]选取85例急性上消化道出血患者为研究对象,根据血压、脉压、血红蛋白等指标分为大量出血组(出血量>800 ml)42例和非大量出血组(出血量≤800 ml)43例,采集2组患者入院时及出血后24 h、48 h、72 h、96 h静脉血液,采用全自动生化分析仪检测血清中BUN和Cr水平,并计算BUN/Cr值,比较不同时期2组患者血清中BUN、Cr水平及BUN/Cr值。[结果]入院时及出血后24 h、48 h、72 h、96 h,大量出血组患者血清BUN水平均高于非大量出血组,差异均有统计学意义(P<0.05);且2组出血后24 h及48 h血清BUN水平均较入院时明显增高,差异有统计学意义(F=5.372、8.632,P<0.05);2组患者血清Cr水平比较差异无统计学意义(P>0.05);2组患者血清BUN/Cr值比较差异有统计学意义(P<0.001);且2组出血后24 h及48 h血清BUN/Cr值较入院时均明显增高,差异有统计学意义(F=5.536、7.638,P<0.05);2组患者BUN/Cr值的峰值均出现在出血后24 h和48 h,出血72 h后明显下降,出血96 h后基本恢复正常水平;且2组BUN/Cr值变化趋势基本一致;但大量出血组患者BUN/Cr值峰值高于非大量出血组。对于消化道出血,血清BUN界定值为5.45 mmol/L,血清Cr界定值为61.34 mmol/L,血清BUN/Cr值界定值为86.9 mmol/L。[结论]血清BUN、Cr及BUN/Cr值可作为诊断和治疗消化道出血的生化指标,BUN/Cr值是鉴别消化道出血的重要依据,应用BUN/Cr值可简便快速且非侵入的估算急性上消化道出血患者出血量,具有较高的临床推广价值。
[Objective]To investigate the application and clinical value of blood urea nitrogen creatinine curve in the of blood loss in patients with acute upper gastrointestinal hemorrhage.[Method]Eighty-five patients with acute upper gastrointestinal hemorrhage admitted from October 2013 to October 2018 were enrolled in the study.According to blood pressure,pulse pressure,hemoglobin and other indicators,they were divided into a large number of bleeding groups(>800 ml)and non-mass Bleeding group(≤800 ml).The venous blood was collected from the two groups at the time of admission and 24 h,48 h,72 h and 96 h after hemorrhage.The levels of BUN and Cr in serum were measured,and the BUN/Cr values were calculated.The levels of BUN,Cr and BUN/Cr in the serum of the two groups were compared.[Results]At the time of admission and 24 h,48 h,72 h,96 h after hemorrhage,the serum BUN level in the patients with bleeding volume >800 ml was higher than the bleeding volume 800 ml group,the difference was statistically significant(P<0.05).The serum BUN level at 48 h was significantly higher than that at admission.The difference was statistically significant(F=5.372,8.632,P<0.05).There was no significant difference in serum Cr level between the two groups(P>0.05).The difference of/Cr ratio was statistically significant(P<0.001).The serum BUN/Cr values of the two groups were significantly higher than those at 24 h and 48 h.The difference was statistically significant(F=5.536,7.638,P<0.05).The peaks of BUN/Cr in both groups occurred at 24 h and 48 h after hemorrhage,and decreased significantly after 72 h,and returned to normal after 96 h;and the BUN/Cr values in the two groups were basically the same;The BUN/Cr value of the 800 ml group was higher than the bleeding volume ≤ 800 ml group.For gastrointestinal bleeding,the defined value of serum BUN was 5.45 mmol/L,the defined value of serum Cr was 61.34 mmol/L,and the defined value of serum BUN/Cr was 86.9 mmol/L.[Conclusion]BUN and Cr and their ratio can be used as biochemical indicators for the diagnosis and treatment of gastrointestinal bleeding.BUN/Cr ratio is an important basis for the identification of upper and lower gastrointestinal bleeding,and has a high clinical value.
作者
於敏
付金金
YU Min;FU Jin-jin(i Digestive Department,Changzhou Tumor Hospital Affiliated to Soochouw University,Changzhou Fourth People's Hospital,213000 Changzhou,China;Digestive Department,Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University,213000 Changzhou,China)
出处
《临床消化病杂志》
2019年第5期289-293,共5页
Chinese Journal of Clinical Gastroenterology
关键词
急性上消化道出血
血尿素氮
肌酐
尿素氮/肌酐值
acute upper gastrointestinal hemorrhage
blood urea nitrogen
creatinine
urea nitrogen creatinine ratio