慢性重型肝炎患者的酸碱平衡特点分析

目的探讨慢性重型肝炎患者血气特点及可能原因。方法用微量血气分析仪测定慢性重型肝炎126例患者动脉血气参数,用静脉血同步测定血钾、血钠、血氯和血尿素氮、血肌酐。先用Kassirer公式初步判断单纯或混合酸碱失衡（ABD）,再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（PB）,判断多重酸碱失衡。结果126例次血气分析中,发生酸碱失衡115例次（91．3％）。其中呼吸性碱中毒合并代谢性碱中毒发生率最高,占31．7％;其次为呼碱合并代酸（25．4％）及单纯呼碱（22．2％）。三重酸碱失衡也以呼碱型TABD为主。肝硬化基础慢重肝与慢性肝炎基础慢重肝患者发生单纯酸碱失衡分别为31．4％、22．5％,发生多重酸碱失衡为65．1％、57．5％,两者相比,无显著性差异。本组共发生低氧血症34例次,占27．0％。pH〈7．35的患者均出现在死亡组。结论慢性重型肝炎患者的酸碱失衡以碱血症为主,呼吸性碱中毒为基本酸碱失衡类型。酸碱失衡与发生慢重肝的基础病变无关。慢重肝患者较易出现轻度低氧血症。血pH值降低是慢重肝死亡的重要因素。

Characteristics of acid-base balance in patients with chronic severe hepatitis: analysis of 126 cases

OBJECTIVE: To investigate the characteristics of acid-base balance in patients with chronic severe hepatitis. METHODS: Samples of venous blood and arterial blood were collected from 126 patients with chronic severe hepatitis, 106 males and 20 females, aged 44 +/- 13 (25 - 74), to undergo measurement of the potassium, sodium, and chloride ions, and urea nitrogen and creatine, blood electrolytes and blood gas analysis respectively. RESULTS: Acid-base disturbance (ABD) was found in 115 of the 126 patients (91.3%). 40 of the 115 patients with ABD (31.7%) had respiratory alkalosis combined with metabolic alkalosis, 32 of them (25.4%) had respiratory alkalosis combined with metabolic acidosis; 28 of them (22.2%) had pure respiratory alkalosis, and 8 (6.3%) had pure metabolic acidosis. Five patients had triple acid-base disturbance, 4 of which had respiratory alkalosis (combined with metabolic alkalosis and metabolic acidosis, 3.2%), and 1 of which had respiratory acidosis (combined with metabolic alkalosis and metabolic acidosis, 0.8%). There was no significantly difference in the prevalence rates of pure acid-base disturbance and multiple acid-base disturbances between the patients with cirrhosis-base chronic severe hepatitis and those with chronic hepatitis-based chronic severe hepatitis. Hypoxia symptoms were seen in 34 patients (27%). 103 patients died. All the 15 patients with their blood pH < 7.35 died. CONCLUSION: ABD in the patients with chronic severe hepatitis is mainly alkalosis with respiratory alkalosis as the basic ABD type. The appearance of ABD is not associated with the underlying illness. Patients of chronic severe hepatitis often suffer from hypoxia. Low blood pH is an important factor causing death.