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題 名 | Plasma Ammonia in Patients with Renal Failure=腎衰竭病人血中氨濃度之探討 |
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作 者 | 周康茹; 鍾孝民; 陳青圃; 賀志強; 方華章; | 書刊名 | 中華民國腎臟醫學會雜誌 |
卷 期 | 8:3 1994.09[民83.09] |
頁 次 | 頁176-182 |
分類號 | 415.815 |
關鍵詞 | Plasma ammonia; Renal failure; |
語 文 | 英文(English) |
中文摘要 | 由於肝臟處理氨的能力很強 , 一般認為只要肝功能正常血中氯濃度應該不會增加。即使腎衰竭病人也不例外。但是我們無意中發現沒有肝臟病史的尿毒症病人血中氮濃度升高。因為腎衰竭病人氮的代謝平衡異於正常,加上血中尿素氮濃度的增加,使我們想到這些因素是否會使血中氯濃度跟著上升。自一九九三年三月到同年八月,我們收集了三組病人,第一組為十二位臨床上診斷為冠狀動脈疾病,病情穩定,肝腎功能檢查正常的病人,當他們接受心導管檢查時,同時檢查病人的動脈血漿氯濃度作為對照組。第二組為二十五位臨床上診斷為單純腎衰竭並且需要洗腎的病人,在洗透析前,檢驗病人的動脈血漿氨濃度。第三組為四位肝硬化合併尿毒症的病人,在透析之前,我們也檢驗其動脈血漿氨濃度。此三組之結果分別為 53.2 ± 16.7 μ g/1, 962 ± 52.0 μ g/1 以及 392.3 ± 83.1 μ g/lo比較第一及第二組之結果,我們發現有十三位 (46%) 病人血中氯濃度大於對照組之平均值加兩個標準差,單純腎衰竭病人之平均血漿氨濃度確實比對照組有意義的增加 (p< 0.05) 。肝硬化合併尿毒症的病人在無明顯腦病變的情形下,其動脈血漿氨濃度可達對照組的三倍甚至四倍以上,而且也比單純尿毒症的病人大兩倍以上。我們的結論是尿毒症病人血中氨濃度可能會經度增加,其最高值可能在正常值的兩倍到三倍之間。而合併肝硬化的尿毒症病人其動脈血漿氨濃度可能會更高。 |
英文摘要 | Ammonia is supposed to convert to urea in the liver so that the blood ammonia levels in patients with renal insufficiency but without liver disease should not be elevated. However, it is uncertain whether uremic patient found to have hyperammonemia is necessarily a case of severe liver disease. From March 1993 to August 1993, in Veterans General HospitalKaohsiung, three groups of patients were collected. The first group consisted of twelve patients who were diagnosed to have coronary artery diseases as well as normal liver and renal function tests when they received coronary angiography. Their arterial plasma ammonia concentrations were checked and taken as the control The second group consisted of thirty-four patients who had renal failure and needed hemodialysis therapy. Before dialysis, we checked their arterial blood pH, bicarbonate, ammonia, and venous blood urea nitrogen, creatinine, sodium, potassium, glucose, AST, ALT, and prothrombin time. The patients who were found to have abnormal AST, ALT or prothrombin time, or who had gastrointestinal bleeding, congestive heart failure, or sepsis were all excluded. Thus, totally twenty-five patients were analyzed. The third group consisted of four patients who were documented to have uremia and liver cirrhosis, with the latter diagnosed by sonography of upper abdomen and biochemical data. Before dialysis, we also checked their arterial plasma ammonia levels. In our study, the average arterial plasma ammonia level in group one was 53.2± 16.7 ug/1, in group two 96.2±52.0 ug/1, and in group three 392.3±83.1 ug/l. There were significant differences between group one and two (p < 0.05) as well as between group two and group three (p < 0.005). Thirteen (46%) patients had blood ammonia levels higher than the normal value plus two standard deviations, and the highest data reached 223ug/l. In conclusion, mild hyperammonemia is not uncommon in patients with renal failure. |
本系統中英文摘要資訊取自各篇刊載內容。