肝硬变腹水患者钾钠氯及酸碱失衡

目的研究肝硬变腹水患者的钾、钠、氯及酸碱失衡。方法肝硬变腹水患者１５４例，血Ｋ＋、Ｎａ＋、Ｃｌ－测定采用ＥＥＬ公司自动分析仪及火焰光度计。血气及酸碱度测定采用ＩＬ１３０２型自动微机分析仪。结果低血钾者５７例，高血钾者６例，低血钠者８１例，高血钠者１２例，低血氯者３４例，高血氯者８例。２４例血气及酸碱度测定结果显示，以碱中毒者为主。依次为呼碱、呼碱＋代酸、代酸、代碱、呼酸。本组高血钾、低血钠与Ｃｈｉｌｄ分级、ＢＵＮ、Ｃｒ值相关。从本组资料表明，重症肝硬变腹水患者水盐代谢失衡多为医源性所致，且加重原有失衡。高钾血症、急性低钠血症及高钠血症大多如此，多为住院后发生，常可危及生命。结论肝硬变腹水患者的高钾血症、低钠血症和高钠血症大多在肝肾功能低下，不适当的治疗所致，是影响预后的重要因素

Serum K Na Cl - and acid_base imbalance in patients with ascitic liver cirrhosis

AIMS To study the serum K , Na , Cl - and acid_base imbalance in patients with ascitic liver cirrhosis. METHODS Serum K , Na and Cl - were determined by EEL autoanalyser, blood gases and serum acid_base were determined by IL 1302 type autoanalyser in 154 patients with ascitic liver cirrhosis. RESULTS Of the 154 cases, 57 were hypokalemia, 6 cases hyperkalemia, 81 cases hyponatremia, 12 cases hypernatremia, 34 cases hypochloremia and 8 cases hypercholremia. Blood gas analysis revealed alkalosis in 13 cases, respiratory alkalosis, 6 cases; respiratory alkalosis with metabolic acidosis, 5 cases; metabolic acidosis, 2 case. The hyperkalemia and hyponatremia were closely related to liver function Child class B and C and increasing of BUN and Cr. Most of the patients with severe hyperkalemia, hypernatremia and hyponatremia were iatrogenic, occured after inadequate therapy, especially under poor hepatic and renal function conditions. CONCLUSIONS Serious hyperkalemia, hyponatremia and hypernatremnia occur in ascitic liver cirrhosis with inadequate therapy.