全身炎症反应综合征/多器官功能障碍综合征患者酸碱失衡的分析

目的提高对全身炎症反应综合征(SIRS)和多器官功能障碍综合征(MODS)患者并发酸碱失衡的认识.方法对2 538例SIRS/MODS患者动脉血气参数(pH、PaO2、PaCO2、HCO3-),酸碱平衡紊乱类型与血清电解质结果进行分析.患者至少符合修订后SIRS标准2项以上(包括发热、体温过低、心动过速、呼吸急促或PaCO2下降、白细胞计数异常);MODS患者则符合各器官功能障碍的诊断标准.结果 2 538例SIRS患者符合2项标准者835例(32.9%),3项者977例(38.5%),4项者726例(28.6%);并发MODS者498例(19.6%);全组死亡282例(11.1%);病死率随SIRS标准的项数增多和MODS患者器官功能障碍数增加而升高(P<0.05).2 538例动脉血气分析中2 129例(83.9%)伴有不同类型的酸碱平衡紊乱,其中单纯酸碱失衡1 227例(57.6%),二重酸碱失衡695(32.6%),三重酸碱失衡207例(9.7%);符合SIRS 2项标准者酸碱失衡557例(26.2%),3项者657例(30.9%),4项者482例(22.6%),MODS者酸碱失衡433例(20.3%).结论 SIRS/MODS患者原发性疾病常可引起呼碱或呼酸,严重者可发生三重酸碱失衡,严重的呼碱并代碱、呼酸并代酸可导致重度的碱血症或酸血症,而使病情加重,甚至致患者死亡.

Disturbance of acid-base balance in patients with SIRS/MODS

Objective To study the disturbance of acid base balance in patients with systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). Methods The parameters such as the arterial blood gasses, types of the acid base disturbance, and results of serum electrolytes with SIRS/MODS were analyzed in 2 538 patients. All patients accorded with at least two of the revised SIRS criteria, including fever, hypothermia, tachycardia, tachypnea, and abnormal white blood cell count or lower PaCO 2. In addition, those with MODS also accorded with the diagnostic criteria for MODS. Results Those who accorded with the two, three, and four of standards for SIRS in 2 538 patients were 835 (32 9%), 977 (38 5%), and 726 (28 6%), respectively. A total of 498 patients (19 6%) were complicated with MODS ( P <0.05), and 282 patients (11 1%) died. The fatality rate increased with the increase of the number of SIRS criteria and dysfunctional organs. Results of arterial blood gas analysis revealed that 2 129 (83 9%) patients out of 2538 cases were complicated with different types of acid base disturbance, among whom 1 227 (57 6%), 695 (32 6%), and 207 patients (9 7%) suffered from pure acid base disturbance, double acid base disturbance, and triple acid base disturbance, respectively. The numbers of the acid base disturbance in patients who accorded with two, three, and four of SIRS criteria were 557 (26 2%), 657 (30 9%), and 482 (22 6%), respectively. Acid base disturbance was found in 433 patients (20 3%) in those with MODS. Conclusion Respiratory alkalosis, respiratory acidosis, and hypoxemia might exist in patients with SIRS/MODS. In addition, metabolic alkalosis might usually occur due to the improper treatment and severe primary disease. The metabolic acidosis might be caused by critical shock, serious hypoxemia, diabetic ketoacidosis, gastrointestinal hemorrhage, and acute renal failure. The triple acid base disorders might occur in serious patients. Respiratory alkalosis plus metabolic alkalosis and respiratory acidosis plus metabolic acidosis might separately lead to severe alkalemia and academia, even death.