Diamond D A, Blight A, Samuell C T, Ransley P G
University of Massachusetts Medical Center, Worcester.
Br J Urol. 1991 May;67(5):541-4. doi: 10.1111/j.1464-410x.1991.tb15203.x.
Hyperammonaemia in the urological patient is a rare and potentially grave condition. It has been reported most frequently in association with ureterosigmoidostomy, where clinical neurological symptoms have developed abruptly in association with markedly elevated plasma ammonia levels. The purpose of this study was to determine whether ureterosigmoidostomy patients might have subclinically elevated plasma ammonia levels, which would put them at risk of subsequently developing hyperammonaemic encephalopathy. Both urine and plasma ammonia levels were assayed in 10 asymptomatic paediatric urological patients with ureterosigmoidostomy. Ten paediatric colocystoplasty patients served as controls. Urine pH and urine ammonia levels were significantly higher in the ureterosigmoidostomy group. There was no significant difference in plasma ammonia levels between ureterosigmoidostomy and colocystoplasty patients. In none of the patients was the plasma ammonia level elevated, but 1 ureterosigmoidostomy patient had an exceedingly high urine ammonia level. It was concluded that an annual serum ammonia level in an asymptomatic ureterosigmoidostomy patient is probably not a valuable screen for subclinical hyperammonaemia.
泌尿外科患者的高氨血症是一种罕见且可能严重的病症。它最常与输尿管乙状结肠吻合术相关，在这种情况下，临床神经症状会随着血浆氨水平显著升高而突然出现。本研究的目的是确定输尿管乙状结肠吻合术患者的血浆氨水平是否可能在亚临床状态下升高，这会使他们有随后发生高氨血症性脑病的风险。对10例无症状的输尿管乙状结肠吻合术小儿泌尿外科患者的尿液和血浆氨水平进行了检测。10例小儿膀胱扩大术患者作为对照。输尿管乙状结肠吻合术组的尿液pH值和尿液氨水平显著更高。输尿管乙状结肠吻合术患者与膀胱扩大术患者的血浆氨水平无显著差异。所有患者的血浆氨水平均未升高，但1例输尿管乙状结肠吻合术患者的尿液氨水平极高。得出的结论是，对无症状的输尿管乙状结肠吻合术患者进行年度血清氨水平检测可能并非筛查亚临床高氨血症的有效方法。
