关键词: 血氨, 肝硬化, 消化道出血, 便秘

Abstract: Objective　To study the changes on plasma ammonia among cirrhosis patients who had gastrointestinal symptoms before and after acidification intestinal treatment， investigate the relationship of gastrointestinal state and plasma ammonia among cirrhosis patients， and find an effective method to reduce plasma ammonia.   Methods　The fast plasma ammonia levels were detected among 195 cirrhosis patients (including 100 patients with just cirrhosis， 52 cirrhosis patients with gastrointestinal hemorrhage and 43 cirrhosis patients with constipation)， 50 patients with just intestinal obstruction， 113 patients with just gastrointestinal hemorrhage and 80 healthy subjects. The plasma ammonia levels were compared， and the changes on plasma ammonia levels before and after acidification intestinal treatment were analyzed in cirrhosis patients with gastrointestinal hemorrhage and (or) constipation.  Results　Plasma ammonia level among cirrhosis patients with gastrointestinal hemorrhage was (67.71±30.31) μmol/L， which was higher than those of patients with just cirrhosis ［(45.81±28.78) μmol/L］， patients with just gastrointestinal hemorrhage ［(24.85±  10.79) μmol/L］ and the healthy controls ［(22.42±7.93) μmol/L］ (P<0.05). The plasma ammonia level of cirrhosis patients with constipation was (95.53±42.61) μmol/L， which was higher than those of patients with just cirrhosis， cirrhosis patients with gastrointestinal hemorrhage and patients with just intestinal obstruction ［(24.90±  11.02) μmol/L］ (P<0.05). The plasma ammonia level of patients with just cirrhosis were higher than those of patients with just gastrointestinal hemorrhage, patients with just intestinal obstruction and healthy subjects (P<0.05), while the plasma ammonia levels among patients with just intestinal gastrointestinal hemorrhage， patients with just obstruction and the healthy subjects showed no significant difference (P>0.05). The plasma ammonia levels of cirrhosis patients with gastrointestinal hemorrhage and (or) constipation before the treatment was (83.28±  37.93) μmol/L， which was higher than the level after the treatment ［(50.89±19.58) μmol/L］ (P<0.05).  Conclusions　Gastrointestinal state is closely related with plasma ammonia levels in cirrhosis patients. Stopping gastrointestinal hemorrhage， acidizing gut and using antibiotic drugs could inhibit the production and absorption of ammonia， and those are effective ways to reduce plasma ammonia levels and to prevent and treat hepatic encephalopathy.

Key words: Plasma ammonia, Cirrhosis, Gastrointestinal hemorrhage, Constipation