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目的 提高对肝性脑病 (HE)发生酸碱平衡紊乱的认识及其与预后的关系。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 (NH3 ) ,用静脉血同步测定血钾 (K+ )、血钠 (Na+ )、血氯 (Cl-)和血尿素氮 (BUN)、血肌酐(Cr)。血气参数按各型酸碱失衡预计代偿公式计算 ,同时计算阴离子隙 (AG)值和潜在碳酸氢根 (HCO-3 )。结果 196例HE中单纯性酸碱平衡紊乱者 6 0例 ,死亡 33例 (5 5 0 % ) ,混合型酸碱平衡紊乱者 136例 ,死亡 111例 (81 6 % ) (P <0 0 1) ;pH <7 30者 2 1例 ,死亡 2 0例 (95 2 % ) ,pH >7 30者 175例 ,死亡 12 4例 (70 9% ) ;PaCO2 ≤ 4 7kPa者 174例 ,死亡 12 9例 (74 1% ) ,PaCO2≥ 6 0kPa者 6例均死亡 ;PaO2 ≤ 10 7kPa者 134例 ,死亡 114例 (85 1% ) ;HCO-3 ≤ 2 2 0mmol/L者 143例 ,死亡 10 8例 (75 5 % ) ,HCO-3 ≥ 2 7 0mmol/L者 19例 ,死亡 16例 (84 2 % )。 196例中死亡 144例 ,病死率为 73 5 %。结论 HE患者并发酸碱平衡紊乱时病死率颇高 ,pH值是影响HE预后的重要因素 ,PaCO2 、PaO2 和HCO-值对HE预后的影响较小。在救治时 ,积极治疗原发病的同时 ,动态监测动脉血气分析 ,尽早发现并及时纠正酸碱平衡紊乱 ,提高HE的救治水平。
Objective To improve the cognition of acid-base balance disturbance in hepatic encephalopathy (HE) and its relationship with prognosis. Methods The arterial blood gas parameters were measured with a micro blood gas analyzer. The same sample was used to measure the blood ammonia (NH3). The blood potassium (K +), Na +, Cl- and BUN ), Serum creatinine (Cr). Blood gas parameters according to various types of acid-base imbalance estimated compensation formula, while calculating the value of anion gap (AG) and potential bicarbonate (HCO-3). Results Sixty-six of the 196 patients with simple acid-base balance disorder in HE were 33 cases (55.0%), 136 were mixed acid-base balance disorders and 111 cases were dead (81.6%) (P <0.01) ); 21 patients with pH <7 30, 20 patients died (95 2%), 175 patients with pH> 7 30, 124 patients died (70 9%); 174 patients with PaCO2 ≤ 47kPa, 12 9 6 cases of PaCO2≥60kPa died, 134 cases of PaO2 ≤107kPa, 114 cases died of (85.1%), 143 cases of HCO-3 ≤220mmol / L, and died of 108 Nineteen cases (75.5%) had HCO-3≥ 270mmol / L and 16 patients died (84.2%). Among 196 cases, 144 died and the case fatality rate was 73.5%. Conclusion The mortality of patients with HE complicated with acid-base balance disorders is high. PH value is an important factor affecting the prognosis of HE. PaCO2, PaO2 and HCO-values have little effect on the prognosis of HE. In the treatment, active treatment of the primary disease at the same time, dynamic monitoring of arterial blood gas analysis, early detection and timely correction of acid-base balance disorders and improve the level of treatment of HE.