酸碱平衡紊乱与肝硬化预后关系的研究

目的探讨肝硬化患者酸碱平衡紊乱的类型、影响因素及其与预后的关系,为临床的诊治提供依据。方法用微量血气分析仪测定动脉血气参数,用静脉血测定血钾（K＋）、血钠（Na＋）、血氯（Cl-）。采用SPSS11.5建立数据库并进行数据分析。结果142例肝硬化患者中,单纯呼吸性碱中毒的有23例,病死率为69.6%;发生呼吸性碱中毒并代谢性碱中毒的有39例,病死率为59.0%。单因素分析结果表明影响肝硬化患者预后的因素可能为年龄、pH、剩余碱（BE）、PaO2、HCO3-等。多因素分析结果表明pH、BE对肝硬化患者的预后有影响,它们的死亡优势比（OR）分别是0.30和0.91,其95%C.I.为0.12～0.71和0.84～0.98。结论肝硬化患者并发酸碱失衡时病死率颇高,pH、BE是影响肝硬化酸碱平衡紊乱患者预后的指标。在救治时,应动态监测患者动脉血气,尤其是pH、BE的变化情况,尽早发现并及时纠正酸碱平衡紊乱,提高肝硬化患者的生存质量,改善预后。

The Relationship between Acid-Base Disorders and Prognosis in Patients with Liver Cirrhosis

Objective To study the relationship between the characteristics of acid-base disorders and prognosis in patients with liver cirrhosis,and provide basis for the clinical diagnosis and treatment for liver cirrhosis patients.Methods The parameter of arterial blood was determined with a microanalyser,K＋,Na＋ and Cl-were determined with vein blood.All the data-base was setting up and analyzed through SPSS11.5 software.Results There were 23 patients suffered from respiratory alkalosis,mortality rate was 69.6%.And there were 39 patients suffered from respiratory alkalosis and metabolic alkalosis,mortality rate was 59.0%.Single factor analysis results showed that the impact factors of the prognosis may be age,pH,bases excess（BE）,PaO2,HCO3-,etc.Multivariate analysis showed that pH,BE were the risk factors of the prognosis,their deaths odds ratio（OR） were 0.30 and 0.91,95%C.I.were 0.12 to 0.71 and 0.84 to 0.98 respectively.Conclusion The mortality rate of the patients was rather high when the patients with liver cirrhosis developed complication of acid-base balance disorders.PH,BE were the risk factors of the prognosis.It was important to dynamically monitor the changes of arterial blood,PH and BE when treating these patients.