急性上消化道出血患者出血量估算中血尿素氮肌酐变化曲线的应用及其临床价值探讨

Application of blood urea nitrogen creatinine curve in the of bleeding volume in patients with acute upper gastrointestinal hemorrhage and its clinical value

[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.