胃黏膜PH值监测早期判断急性脑出血患者预后的临床研究
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摘要
目的胃黏膜PH值(Intramucosal PH,PHi)监测广泛的应用于各种危重病患者的救治,是一种早期、灵敏、经济、可靠的方法。本实验研究探讨胃黏膜PH值监测对早期判断急性脑出血患者预后及并发症的临床意义,为临床上急性脑出血患者病情及预后的判断提供可靠的实验依据,提高对急性脑出血患者的诊断、治疗水平,降低急性脑出血患者的并发症及死亡率。
方法随机选择河南大学第一附属医院神经内科2009.1～2010.1收治的38例急性脑出血患者,男性21例,女性17例。年龄40～80岁,平均年龄60.25±8.20岁,合并高血压病28例,合并糖尿病13例,出血量≥30ml15例,出血量<30 ml23例,壳核出血25例,丘脑出血9例,脑干出血4例。全部均符合1995年全国中华神经学会修改的《各类脑血管病诊断要点》中的诊断标准,格拉斯哥昏迷评分3～10分,所有的患者均无肝肾疾患,并排除由外伤、肿瘤及血液病引起的脑出血。入院后所有患者均给予脑出血常规治疗,静脉给予奥美拉唑,测PHi值期间全部禁食。全部患者入院后均给予生命体征监测,24小时内抽静脉血进行常规化验。患者入院30分钟和24小时进行胃黏膜PH值监测,进行APACHⅡ及GCS评分。根据入院1周内是否死亡,将患者分成生存组与死亡组;入院后1周内根据全身性感染性相关性脏器功能衰竭评价(SOFA)标准及Coris的多脏器功能衰竭(MOF)评分标准进行评分,将患者分成未发生与发生MODS组。比较分析胃黏膜PH值、APACHⅡ及GCS评分在急性脑出血患者的预后、并发症预测中的敏感性。胃黏膜PH值测量采用盐水张力计法。所得数据以均值±标准差( x±s)表示,应用SPSS12.0统计学软件对数据进行统计学处理,P<0.05为有统计学意义,P<0.01为有显著统计学意义。
结果38例患者入院一周死亡11例,发生MODS 8例。死亡组与生存组,发生与未发生MODS组患者的年龄、性别、体重无统计学差别。在入院30分钟的胃黏膜PH值,死亡组低于存活组(P<0.05), APACHⅡ评分死亡组高于生存组(P>0.05),GCS评分死亡组低于生存组(P>0.05);在入院24小时的胃黏膜PH值死亡组低于存活组(P<0.01), APACHⅡ评分死亡组高于生存组(P<0.05),GCS评分死亡组低于生存组(P<0.05)。发生与未发生MODS组比较,入院30分钟胃黏膜PH值,发生MODS组低于未发生MODS组(P<0.05), APACHⅡ评分发生MODS组高于未发生MODS组(P>0.05),GCS评分发生MODS组低于未发生MODS组(P>0.05);入院24小时发生与未发生MODS组比较,胃黏膜PH值发生MODS组低于未发生MODS组(P<0.01), APACHⅡ评分发生MODS组高于未发生MODS组(P<0.05),GCS评分发生MODS组低于未发生MODS组(P<0.05)。
结论胃黏膜PH值监测做为一个间接测定局部组织氧和情况的指标对早期判断急性脑出血患者的预后与并发症有重要意义。
Objectve: The gastric intramucosal PH (PHi) monitoring has widely applicable value in the diagnosis and treatment for different serious illness. It is a primitive, sensitive, economical and depensable monitoring method. The text had been done to study the clinical significance of the gastric intramucosal PH. It provide experimental evidence for the clinic diagnosis and prognosis on acute intracebral hemorrhage patients. It raises the diagnosis and treatment levels on acute intracebral hemorrhage patients. .It bring down the complications and mortalities of acute intracebral hemorrhage patients.
Methods: Texts had been done on the gastric intramucosal PH(PHi) of 38 acute intracerebral hemorrhage patients in the neurology of the first affiliate hospital of Henan University. Among these patients . there are 21 males and 17 females, aged 40-80 years. The average age is 60.25±8.20 years. 28 patients merge hypertension and 18 merge diabete. The amount of blooding≥30ml is 15, and <30ml 23 (the number of putminal hemorrhage is 25, thalamic hemorrhage 9 and brainstem hemorrhage 4). All these disease accord with the diagnostic criteria of“Diagnostic Poit of All Naoxueguanbing”which is altered in chinese nerves academy,1995. The Glasgow Coma Score of these patients is 3-10. All these patients were given the conventional therapy. We measure the gastric intramucosal PH on these patients,and then compare with APACHⅡ( Acute Physiologic and Chronic Heath Evaluation )and GCS (Glasgow Coma Score)on the first 30 minites and the first 24 hours after been admitted to hospital. These patients are scored according the SOFA score (Sepsis-related Organ Failure Assessment) and Goris’s MOF(Multiple Organ Failure)score in the first week . The patients are devided into survival group and dead group,no MODS(Multiple Organ Dysfunction Syndrome)complication group and MODS complication group. We analyse which one is the most sensitive method to pridict the prognosis and complication of the acute intracebral hemorrhage patients. The salt water tension instrument method is adopt in monitoring the gastric intramucosal PH. Datas were expressed as means±SEM, analysis were done by SPSS 12.0, P < 0.05 was considered significant , P < 0.01 was highest significant.
Results: Among the 38 cases,11 cases died within 1 week. Comparing dead and survival group,in the beginning 30 minites ,the results of the gastric intramucosal PH (PHi) decreased dramatically(P<0.05),but the APACHⅡwere the same(P>0.05) and GCS were the same(P>0.05).After 24 hours,comparing with the two groups,the results of PHi were different (P<0.01),the APACHⅡw ere different (P<0.05) and GCS were different (P<0.05). 8 cases among these 38 cases suffered from Multiple Organ Dysfunction (MODS). Comparing with the other group, in the beginning 30 minites,the results of PH (PHi) were significantly lower (P<0.05),but the APACHⅡwere the same (P>0.05) and the GCS were the same (P>0.05 ) .After 24 hours the results of PH (PHi) were significantly lower (P<0.01),while the APACHⅡwere higher (P<0.05) and the GCS were lower (P<0.05).
Conclusion: As one early detector of ischemia of internal organs,the gastric intramucosal PH(PHi) has important clinical significance in early prognosis in acute intracerebral hemorrhage patients.
方法随机选择河南大学第一附属医院神经内科2009.1～2010.1收治的38例急性脑出血患者,男性21例,女性17例。年龄40～80岁,平均年龄60.25±8.20岁,合并高血压病28例,合并糖尿病13例,出血量≥30ml15例,出血量<30 ml23例,壳核出血25例,丘脑出血9例,脑干出血4例。全部均符合1995年全国中华神经学会修改的《各类脑血管病诊断要点》中的诊断标准,格拉斯哥昏迷评分3～10分,所有的患者均无肝肾疾患,并排除由外伤、肿瘤及血液病引起的脑出血。入院后所有患者均给予脑出血常规治疗,静脉给予奥美拉唑,测PHi值期间全部禁食。全部患者入院后均给予生命体征监测,24小时内抽静脉血进行常规化验。患者入院30分钟和24小时进行胃黏膜PH值监测,进行APACHⅡ及GCS评分。根据入院1周内是否死亡,将患者分成生存组与死亡组;入院后1周内根据全身性感染性相关性脏器功能衰竭评价(SOFA)标准及Coris的多脏器功能衰竭(MOF)评分标准进行评分,将患者分成未发生与发生MODS组。比较分析胃黏膜PH值、APACHⅡ及GCS评分在急性脑出血患者的预后、并发症预测中的敏感性。胃黏膜PH值测量采用盐水张力计法。所得数据以均值±标准差( x±s)表示,应用SPSS12.0统计学软件对数据进行统计学处理,P<0.05为有统计学意义,P<0.01为有显著统计学意义。
结果38例患者入院一周死亡11例,发生MODS 8例。死亡组与生存组,发生与未发生MODS组患者的年龄、性别、体重无统计学差别。在入院30分钟的胃黏膜PH值,死亡组低于存活组(P<0.05), APACHⅡ评分死亡组高于生存组(P>0.05),GCS评分死亡组低于生存组(P>0.05);在入院24小时的胃黏膜PH值死亡组低于存活组(P<0.01), APACHⅡ评分死亡组高于生存组(P<0.05),GCS评分死亡组低于生存组(P<0.05)。发生与未发生MODS组比较,入院30分钟胃黏膜PH值,发生MODS组低于未发生MODS组(P<0.05), APACHⅡ评分发生MODS组高于未发生MODS组(P>0.05),GCS评分发生MODS组低于未发生MODS组(P>0.05);入院24小时发生与未发生MODS组比较,胃黏膜PH值发生MODS组低于未发生MODS组(P<0.01), APACHⅡ评分发生MODS组高于未发生MODS组(P<0.05),GCS评分发生MODS组低于未发生MODS组(P<0.05)。
结论胃黏膜PH值监测做为一个间接测定局部组织氧和情况的指标对早期判断急性脑出血患者的预后与并发症有重要意义。
Objectve: The gastric intramucosal PH (PHi) monitoring has widely applicable value in the diagnosis and treatment for different serious illness. It is a primitive, sensitive, economical and depensable monitoring method. The text had been done to study the clinical significance of the gastric intramucosal PH. It provide experimental evidence for the clinic diagnosis and prognosis on acute intracebral hemorrhage patients. It raises the diagnosis and treatment levels on acute intracebral hemorrhage patients. .It bring down the complications and mortalities of acute intracebral hemorrhage patients.
Methods: Texts had been done on the gastric intramucosal PH(PHi) of 38 acute intracerebral hemorrhage patients in the neurology of the first affiliate hospital of Henan University. Among these patients . there are 21 males and 17 females, aged 40-80 years. The average age is 60.25±8.20 years. 28 patients merge hypertension and 18 merge diabete. The amount of blooding≥30ml is 15, and <30ml 23 (the number of putminal hemorrhage is 25, thalamic hemorrhage 9 and brainstem hemorrhage 4). All these disease accord with the diagnostic criteria of“Diagnostic Poit of All Naoxueguanbing”which is altered in chinese nerves academy,1995. The Glasgow Coma Score of these patients is 3-10. All these patients were given the conventional therapy. We measure the gastric intramucosal PH on these patients,and then compare with APACHⅡ( Acute Physiologic and Chronic Heath Evaluation )and GCS (Glasgow Coma Score)on the first 30 minites and the first 24 hours after been admitted to hospital. These patients are scored according the SOFA score (Sepsis-related Organ Failure Assessment) and Goris’s MOF(Multiple Organ Failure)score in the first week . The patients are devided into survival group and dead group,no MODS(Multiple Organ Dysfunction Syndrome)complication group and MODS complication group. We analyse which one is the most sensitive method to pridict the prognosis and complication of the acute intracebral hemorrhage patients. The salt water tension instrument method is adopt in monitoring the gastric intramucosal PH. Datas were expressed as means±SEM, analysis were done by SPSS 12.0, P < 0.05 was considered significant , P < 0.01 was highest significant.
Results: Among the 38 cases,11 cases died within 1 week. Comparing dead and survival group,in the beginning 30 minites ,the results of the gastric intramucosal PH (PHi) decreased dramatically(P<0.05),but the APACHⅡwere the same(P>0.05) and GCS were the same(P>0.05).After 24 hours,comparing with the two groups,the results of PHi were different (P<0.01),the APACHⅡw ere different (P<0.05) and GCS were different (P<0.05). 8 cases among these 38 cases suffered from Multiple Organ Dysfunction (MODS). Comparing with the other group, in the beginning 30 minites,the results of PH (PHi) were significantly lower (P<0.05),but the APACHⅡwere the same (P>0.05) and the GCS were the same (P>0.05 ) .After 24 hours the results of PH (PHi) were significantly lower (P<0.01),while the APACHⅡwere higher (P<0.05) and the GCS were lower (P<0.05).
Conclusion: As one early detector of ischemia of internal organs,the gastric intramucosal PH(PHi) has important clinical significance in early prognosis in acute intracerebral hemorrhage patients.
引文
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[33]吴钦,宋越红.胃粘膜pH值监测早期判断危重患者预后的临床研究.广西医学,2004,26(9):1611-1613.
[34]田道锋,邹瑛等.重型颅脑损伤患者胃粘膜内PH的监测及临床意义.胃肠病学,2005,10(4)::227-229.
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[41] Nordin Aron MD,Makisalo .et al.Gut intramucosal PH as an early indicator of effetiveness of therapy for hemorrhagic shok [J].Crit Care Med,1998,26:1110-1117.
[42] Gutierrez G,Fizas F,Dnglio G,et a1.Gastric intramucosal PH is a therapeutic index at tissue oxygenation in critically ill patients.Lancet,1991,39:195.
[43] Silva Eliezer MD DeBakeer,et al.Effects of vasoactive drugs on gastric intramucosal PH [J]. Crit Care Med,1998,26(10):1749-1758.
[44]王今达,王宝恩.多脏器失常综合征(MODS)病情分期诊断及严重程度评分标准.中国危重病急救医学,1995,7(6):346.
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[46] Bone RC.Immunologic dissonance:A continuing evolution in our undersdanding of the systemic inflammatory response syndrome(SIRS) and the multiple organ dysfuction syndrome (MODS).Ann Intern Med,1996,125:680-687.
[47]倪宏伟.奥美拉唑在颅脑手术中对胃泌素和胃黏膜PH值的影响.2008-大连医科大学:麻醉学.
[48]赵峰,祝禾辰.胃黏膜PH监测对重度急性颅脑外伤患者的临床意义.中国急救医学,2004,24(10):707-709.
[49] Bonham,Abu-Zidan,Simoric.Gastric intramucosal PH predicts death in sever acute patients[J].Br J Sug,1997,84(12):1670-1674.
[50] Miller PR,Kincaid EH,Meredith JM et al.Threshold values of intramucosal PH and mucosal arterial CO2gap during shock Resuscitation [J].J Trauma,1998,45:868-872.
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