Diebel L, Kozol R, Wilson R F, Mahajan S, Abu-Hamdan D, Thomas D
Department of Surgery, Veterans Administration Medical Center, Allen Park.
Surgery. 1993 May;113(5):520-6.
Patients with chronic kidney failure have an increased incidence of gastrointestinal complications, particularly bleeding from the stomach. Diminished mucosal blood flow is thought to be an important etiologic factor for such bleeding.
Eleven patients with kidney failure on maintenance dialysis underwent placement of a gastric tonometer for the determination of gastric intramucosal pH (pHi) before and during dialysis. The arterial pH (pHa), calculated pHi, and pHa-pHi differences were compared with the results in a control group of seven normal volunteers.
The patients with chronic kidney failure had a mean (+/- SD) pHa (7.36 +/- 0.04) similar to that found in seven control subjects (7.37 +/- 0.04). However, the gastric mucosal pH in the patients on dialysis (7.20 +/- 0.17) was lower than in the seven control subjects (7.38 +/- 0.06) (p < 0.01). A gastric mucosal pH thought to be predictive of either bleeding from stress ulceration (pHi < 7.32) or mucosal ischemia (pHi-pHa difference > 0.13) was found in nine (82%) of the patients with kidney failure and in only one (14%) of the control subjects (p < 0.001).
This new preliminary finding suggests that the high incidence of gastric bleeding in chronic kidney failure may be related to mucosal ischemia.
慢性肾衰竭患者胃肠道并发症的发生率增加，尤其是胃出血。黏膜血流量减少被认为是此类出血的一个重要病因。
11例维持性透析的肾衰竭患者在透析前和透析期间放置胃张力计以测定胃黏膜内pH值（pHi）。将动脉血pH值（pHa）、计算得出的pHi以及pHa-pHi差值与7名正常志愿者组成的对照组的结果进行比较。
慢性肾衰竭患者的平均（±标准差）pHa（7.36±0.04）与7名对照受试者（7.37±0.04）相似。然而，透析患者的胃黏膜pH值（7.20±0.17）低于7名对照受试者（7.38±0.06）（p<0.01）。在9例（82%）肾衰竭患者中发现胃黏膜pH值被认为可预测应激性溃疡出血（pHi<7.32）或黏膜缺血（pHi-pHa差值>0.13），而在对照受试者中仅1例（14%）出现这种情况（p<0.001）。
这一新的初步发现表明，慢性肾衰竭患者胃出血的高发生率可能与黏膜缺血有关。
