Assessment of Gastric Intramural PH and Risk Factors in Critically Ill Ratients with Upper Gastrointestinal Bleeding

重症病人胃壁內酸鹼值和危險因子在併發上胃腸道出血之評估

吳振力(Jun-Lin Ng) ； 魏明忠(Ming-Chung Wei) ； 李懋華(Mau-Hwa Lee) ； 陳奇峰(Chyi-Fong Chen) ； 林垂裕(Chwei-Yuh Lin)

《中華民國消化系醫學會雜誌》 8卷4期 (1991/12) Pp. 259-265

https://doi.org/10.6557/GJTa.199112_8(4).0003

摘要

壓力性潰瘍併發急性上胃腸道出血，對重症病人是一種嚴重的併發症。為了分析胃壁內酸鹼值和危險因子在預測重症病人發生上胃腸道出血之關係，我們提出一種簡單而非侵襲性的評估方法。研究方法取材自40名加護病房之重症病人和10名正常人作對照組．經由胃液之PCO2值與動脈血之[HCO3^-]值，利用Henderson-Hasselbach 方程式算出胃壁內酸鹼值(pHi)。產生壓力性潰瘍之危險因子包括：低血壓、敗血症、重要生命器官衰竭、重大手術、嚴重外傷和燒傷。上胃腸道出血之表現為胃抽取液或大便有潛血反應，甚至明顯的有解黑便或吐血。全部50人分為三組：併發出血之重症病人有24名、無出血之重症病人有16名、無出血和不含危險因子之正常對照組有10人。本研究結果如下：(l)出血病人組之平均胃壁內酸鹼值(7.36±0.27)較無出血病人組(7.74±0.34)和正常對照組(7.65±0.14)為低，統計學上為有意義之差別；(2)危險因子數目之多寡，在出血病人組和對照組間也有明顯之差異：(3)當我們截取胃壁內酸鹼值7.46為上胃腸道出血之臨界值(cut-off value)時，31.3%(5/16)的無出血病人組和66.7%(l6/24)的出血病人組，其胃壁內酸鹼值低於7.46，而所有正常對照組之胃壁內酸鹼值均高於7.46；(4)病人組開始出血之平均天數為1.75日；(5)併發上胃腸道出血病人之死亡率為66.7%(16/24)，無出血者為25%(4/16)。胃壁內酸鹼值的下降和危險因子數目的增加，不只是造成上胃腸道出血之主要誘因之一；而且可使吾人提高警覺，並積極的投予抗潰瘍藥物之預防治療。所以，在評估重症病人併發上胃腸道出血之罹患率或死亡率時，胃壁內酸鹼值和危險因子數目多寡之分析，是一種方便可靠的方法。

關鍵字

胃壁內酸鹼值(pHi) ； 危險因子 ； 上胃腸道出血

並列摘要

Acute upper gastrointestinal bleeding from stress ulceration is a serious life- threatening complication in morbidly ill patients. To clarify the relationship between gastric intramural pH (pHi) and risk factors in critically ill patients, we used an indirect and non-invasive method in predicting the occurrence of massive upper gastrointestinal bleeding. The studied subjects included 40 patients from the intensive care unit and 10 healthy volunteers. Among the 40 critically ill patients, 24 had upper gastrointestinal bleeding whilst the remaining 16 patients did not exhibit gastrointestinal bleeding. The intramural pH (pHi) in the stomach was calculated from the Henderson-Hasselbach equation with the PCO2 in gastric juice and the [HCO3^-] in arterial blood. Our results show that: (1) There was a lower value of mean pHi 7.36 ± 0.27 in the bleeding patient group compared to pHi 7.74 ± 0.34 in the non-bleeding patient group with pHi 7.65 ± 0.14 in the normal control group (p ＜ 0.05, either); (2) Risk factor score was significantly different in the bleeding patient group from the normal control group (3.42 ± 1.44 vs. 0, p ＜ 0.05); (3) Since pHi of all the normal controls (10/10) was above 7.46, we used this limit as the cut-off value of pTh; suggesting that 31.3 % (5/16) of subjects in the non-bleeding patient group and 66. 7% U6/24) of subjects in the bleeding patient group recorded pHi's which had fallen below the cut-off value of 7.46; (4) The average time of bleeding after admission was 1.75 ± 1.11 days; (5) Patients who bled had a 66.7 % (16/24) mortality rate compared with a 25.0 % (4/16) rate in patients who did not bleed. In conclusion, the low gastric intramural pH and high risk factor scores in critically ill patients may be two predisposing factors for upper gastrointestinal bleeding and indications for anti-ulcer prophylactic therapy.

並列關鍵字

gastric intramural pH (pHi) ； risk factors ； upper gastrointestinal bleeding