study state of arterial blood gases (o2, co2) in patients with cirrhosis

Study state of arterial patients with cirrhosis Vu Thi Thu Tra Leader: Ph.D.. - Cirrhosis were frequent disease - Cirrhosis influence to many organisms: kidney, cerebrum, cardiac, pulm

Study state of arterial

patients with cirrhosis

Vu Thi Thu Tra Leader: Ph.D Nguyen Thi Van Hong

- Cirrhosis were frequent disease

- Cirrhosis influence to many organisms: kidney, cerebrum, cardiac, pulmonary…

- hps: Liver disease + hypoxemia +

intrapulmonary vascular dilatations (IPVDs)

- IPVDs : difficult to determination

- Change in the arterial blood gas: easy discover

Observe state of arterial blood gases (O 2 , CO 2 ) in

patients with cirrhosis

Tæng quan

TiÕn triÓn cña x¬ gan: tæn th ¬ng kh«ng håi phôc

Tổng quan

Giảm oxy máu

- Là chỉ điểm của HCGP

- Giảm oxy máu càng nặng càng khẳng định HCGP

- Xác định giảm oxy máu động mạch thông qua PaO 2

và AaDO 2 (Là chênh áp oxy phế nang – 29% mao mạch, đ

ợc cho là nhạy hơn PaO 2 trong việc xác định có giảm oxy máu)

60 ≤ PaO 2 < 80mmHg : HCGP nhẹ và vừa

50 ≤ PaO 2 < 60mmHg: HCGP nặng

PaO 2 < 50mmHg : HCGP rất nặng

Tổng quan

- Cơ chế giảm oxy máu: Giả định gồm

Shunt động-tĩnh mạch

V/Q mismatch (Không phù hợp thông khí và thông máu phổi)

Hạn chế khuyếch tán oxy phế nang - mao mạch

Sự thay đổi ái tính của oxy với Hemoglobin

Tæng quan

Gi·n m¹ch m¸u trong phæi

ThÓ hiÖn d íi 2 type:

- Gi·n tr íc mao m¹ch vµ mao m¹ch

Tæng quan

ChÈn ®o¸n HCGP:

BÖnh lý gan m¹n tÝnh

Gi¶m oxy m¸u

Gi·n m¹ch m¸u trong phæi

Patients and methods

- Clinical, laboratory, endoscopy and radiologic

manifestations were not adequate:

laparoscopic or liver biopsy

Patients and methods

 Criteria were excluded for inclusion in the study:

- Patients with respiratory, cardiac disease

- Patients with cirrhosis has pleural effusion

- Patients deny and uncooperative study

Patients and methods

Child-Pugh classification of severity of liver disease

Parameter Points assigned

Albumin, g/dL > 3.5 2.8-3.5 < 2.8 Bilirubin, mg/dL < 2 2-3 > 3

Encephalopathy None Grade 1-2 Grade 3-4 Prothrombin time, % > 54 45 54– 54 < 45

C-P A: 5-6 C-P B : 7 9– 54 C–P C: ≥ 10

Patients and methods

Determining the cause of cirrhosis:

- Hepatitis virus:

• Hepatitis B virus when has HBsAg positive

• Hepatitis C virus when has Anti-HCV positive

- Alcoholic

- Other causes

Patients and methods

Patients and methods

2 Methods

- Study design: Cross sectional study, prospective

- Sample size: 60 patients

3 Statistical analysis :

The statistical analysis was performed using the EPI-INFO 6.04

Results and and Discussion Discussion

Gender distribution

Male/Female: 3.6/1

Chu Thi Kim Hanh: 3.5/1

Pham Thi Phuong Hanh: 3.4/1

78%

22%

Male Female

Child-Pugh A: 10 patients (16.7%), CP B:15 patients(25%),

CP C: 35 patients (58.3%)

Chu Thi Kim Hanh: CP A: 22.2%, CP B:39.5%, CP C:38.5%

cause distribution

Hepatitis virus and Alcoholic: 90%

Chu Thi Kim Hanh: 78%

Alcoholic

Alcoholic

+ Hepatitis virus

Other

P a O2 and age

Age mean of group hypoxemia : 48.1 ± 14.4

Age mean of group non hypoxemia : 52.9 ± 10.2

p > 0.05

Hakan Gunen: 49.8 ± 19.7 vµ 53.2 ± 10.9 (p > 0.05)

44 46 48 50 52 54

Age

PaO2 ≥ 80 PaO2 < 80

PaO2 ? 80 PaO2 < 80

Male Female

≥

Patients rate in grade hypoxemia

Patients has hypoxemia: 48.3%

P a O2 and grade cirrhosis

Similar: Culafic DJ vµ Krowka MJ

Opposite: Schenk P

CP A 81.7 ± 8.7

CP B 82.2 ± 11.7

CP C 78.7 ± 10.2

P a O2 and ascites

Hakan Gunen and Oradiales Fernandez:

PaO improve significantly after paracentesis ascites

Absent 80.4 ± 11.8

Moderate 82.1 ± 9.6

Large 77.1 ± 9.7

Patients rate in grade A a DO2

Rolla:17.3, Naeji 34.4, Bashour:48.4, Hourani:36.7mmHg

Schenk P: 82%, Tulafic: 58%, Hourani: 45%, Fahy: 69%

30

38.8

21.7

10 0

5 10 15 20 25 30 35 40

%

A a DO2 and grade cirrhosis

Similar: Colle I, Langlet P

CP A 20,9 ± 10,5

CP B

27 ± 13,3

CP C 28,4 ± 11,7

A a DO2 and grade ascites

Inconformity with grade ascites not significant, p > 0.05

Absent 25.2 ± 24.9

Moderate 25.8 ± 11.5

Large 29.7 ± 11.6

P a CO2 and grade cirrhosis

PaCO 2 TB: 36.8 ± 6.6mmHg

Charalabopoulos: 33.9 ± 1.5

CP A 40.3 ± 5

CP B 36.9 ± 6,5

CP C 35.9 ± 7.0

P a CO2 and grade ascites

Oradiales: after paracentesis ascites PaCO 2 idempotent

Absent 38.1 ± 4.8

Moderate 37.5 ± 5.9

Large 34.4 ± 8.4

S a O2 and grade cirrhosis

Inconformity with grade cirrhosis not significant, p > 0,05

SaO 2 CP A

95,6 1,4 ± 1,4

CP B 96,0 1,9 ± 1,4

CP C 95,6 1,8 ± 1,4

< 95% 3 30 5 33,3 11 31,4 Total 10 100 15 100 35 100

S a O2 and grade ascites

Inconformity with grade ascites not significant, p > 0.05

Absen 95.4 ± 2.1

Moderate

96 ± 1.7

Large 95.2 ± 1.4

- Impaired arterial oxygenation (PaO2 less

than 80mmHg): 48.3% of cirrhosis

- AaDO2 greater than 20mmHg: 70%

- SaO2 less than 95%: 31.7%

- PaCO2 less than 35mmHg: 36.7%

- pH greater than 7.45: 21.7%