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目的探讨酸碱平衡紊乱,血氨水平及肝脏储备功能对肝性脑病(HE)预后的影响。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(NH_3),用静脉血同步测定血钾(K~+)、血钠(Na~+)、血氯(CI~-)。血气参数按各型酸碱失衡预计代偿公式计算,同时计算阴离子间隙(AG)和潜在的碳酸氢根(HCO_3~-)。肝脏储备功能按 Child-Pugh 评分分 A 级、B 级、C级。结果 101例肝性脑病(HE)中均有酸碱平衡紊乱,以呼碱型酸碱紊乱为主,共74例,三重酸碱紊乱(TABD),呼吸性碱中毒合并代谢性酸中毒,呼吸性碱中毒合并代谢性碱中毒,不仅发病率高,病死率也高,分别为94.4%、81.8%、72.2%。血氨升高在碱中毒时升高明显。肝功能 B、C 级组死亡率明显高于 A 级组。结论 HE 患者并发呼碱型酸碱紊乱病人死亡率高,碱中毒时血氨升高对 HE 预后有重要影响,同时二者又相互关联共同增加死亡率。同时 HE 的发生、发展与肝脏的储备功能密切相关。
Objective To investigate the effects of acid-base balance disorder, serum ammonia level and liver reserve on the prognosis of hepatic encephalopathy (HE). Methods The arterial blood gas parameters were measured by micro blood gas analyzer. The same sample was used to determine the concentration of ammonia nitrogen (NH 3). The blood potassium (K ~ +), Na ~ + and CI ~ - were measured synchronously with venous blood. Blood gas parameters according to various types of acid-base imbalance estimated compensation formula, while calculating the anion gap (AG) and potential bicarbonate (HCO 3 - -). Liver reserve function according to Child-Pugh score points A, B, C level. Results 101 cases of hepatic encephalopathy (HE) were acid-base balance disorders, mainly to alkaloid acid-base disorders, a total of 74 cases, triple acid-base disorders (TABD), respiratory alkalosis with metabolic acidosis, Alkalosis combined with metabolic alkalosis, not only the high incidence and high mortality were 94.4%, 81.8%, 72.2%. Increased blood ammonia in alkaline poisoning increased significantly. Liver function B, C group mortality was significantly higher than the A group. Conclusions The mortality of HE patients with hypersensitivity to alkaloid-acid-base disorder is high, and elevated serum ammonia in alkalosis has an important effect on the prognosis of HE, and the two are associated with each other to increase the mortality rate. At the same time, the occurrence and development of HE are closely related to the reserve function of liver.