慢性阻塞性肺病急性加重期慢性呼吸衰竭时酸碱失衡分析

目的：探讨慢性阻塞性肺病急性加重期呼吸衰竭时酸碱失衡的特点。方法：回顾性分析2004年7月至2009年12月慢性阻塞性肺病急性加重期呼吸衰竭时440例患者1530例次动脉血气电解质结果及相关临床资料,判断呼吸衰竭时酸碱失衡类型。结果：1530例次血气分析中,呼酸代碱620例次（40.52%）,代碱247例次（16.14%）,呼酸型三重酸碱失衡163例次（10.65%）,呼碱型三重酸碱失衡104例次（6.80%）,正常88例次（5.75%）,高阴离子间隙代酸81例次（5.30%）,呼酸62例次（4.05%）,呼碱代酸39例次（2.55%）,呼碱代碱32例次（2.09%）,呼酸代酸31例次（2.03%）,代酸呼碱27例次（1.76%）,呼碱18例次（1.18%）,代酸18例次（1.18%）。慢性阻塞性肺病急性加重期合并肺心病者发生三重酸碱失衡111例（34.69%）,未合并肺心病者发生三重酸碱失衡29例（24.17%）,两组间有显著性差异（P〈0.05）;而有肺心病者心功能Ⅰ级发生三重酸碱失衡1例,Ⅱ级发生三重酸碱失衡15例,Ⅲ级发生三重酸碱失衡37例,Ⅳ级发生三重酸碱失衡58例,心功能级别间发生三重酸碱失衡有显著性差异（P〈0.05）。结论：对慢性阻塞性肺病急性加重期呼吸衰竭时酸碱失衡的特点,较既往报道有所不同,呼酸代碱及代碱发生率较前明显增高,三重酸碱失衡发生率明显增高,新近报告高阴离子间隙代酸的出现,均应引起临床医师的重视。     

慢性肾功能衰竭酸碱失衡的规律探讨

65例CRF病人71例次的动脉血气分析,7例次正常(占9.8%),64例次伴有酸碱失衡(占90.2%);其中代酸33%例次(占46.5%),代酸 呼碱25例次(占35.2%),代酸 呼碱 代碱6例次(占8.4%).随着肾功能损害的加重,复合性酸碱失衡出现率逐渐增高,这是CRF酸碱失衡的一大特点,也是造成CRF病人死亡的原因之一.分析提出:为了防止医源性加重酸碱失衡,减少CRF的死亡率,不能简单地依靠二氧化碳结合率来判断酸中毒的轻重,必须进行血气分析,以准确判断酸碱失衡的类型和轻重程度,指导临床治疗.     

慢性呼吸衰竭急性加重期酸碱失衡临床分析

目的 :探讨慢性呼吸衰竭急性加重期酸碱失衡类型 ,为早期防治提供依据。方法 :同步测动脉血气分析和电解质分布 ,以酸碱失衡预计代偿公式、结合 AG值和潜在 HCO- 3 对 2 5 9例次慢性呼吸衰竭急性加重期患者进行酸碱失衡类型判断。结果 :2 5 9例次患者酸碱失衡 2 5 0例次 (96 .5 3% ) ,其中单纯呼酸 115例次 (4 4.40 % )最常见 ,其次为呼酸代碱 82例次 (31.6 6 % )。经 AG值判断 ,代酸由 12例次增至 41例次 ,三重酸碱失衡由 0例次增至 19例次 ,结合潜在 HCO3 - 有 9例次提示代碱。结论 :慢性呼衰急性加重期酸碱失衡发病率高 ,类型复杂 ;AG值及潜在 HCO- 3 对代酸及三重酸碱失衡判断有重要意义。     

AG 测定在判断肺心病酸碱失衡上的临床应用

本文报告了我院近二年收治的符合肺心病诊断标准,材料较全的51例肺心病患者,计算 AG(阴离子间隙)及潜在碳酸氢,并结合临床进行了酸碱失衡分析,有33例(67%)存在着不同程度各型酸碱失衡,其中28例(59.9%)存在呼酸,代酸有关酸碱失衡。现总结如下:     

急性呼吸窘迫综合征患者酸碱失衡与电解质紊乱的临床分析

目的不同病因的ARDS酸碱失衡与电解质紊乱的类型与特点。方法对159例ARDS患者进行动脉血气及血清电解质的监测。并按病情轻重程度将病人分为轻度组和中、重度组。结果轻度的ARDS以呼碱,呼碱并代碱和代酸最常见,其中轻度组的99例ARDS中单纯呼碱的为85例(85.9﹪),其发生率有显著性差异(P<0.05)中、重度ARDS均有复杂的酸碱失衡的类型存在,其中以呼碱型三重酸碱失衡、呼酸并代酸、呼碱并代酸最多见。并随病情加重,三重型酸碱失衡的发生率明显增高,并且死亡率也随之而增高。结论中、重度(ARDS)如出现呼碱型三重酸碱失衡、呼酸并代酸等。提示病情险恶,预后极差,应及时处理。因此,及时正确识别是实施正确治疗并提高治愈率的关键。     

烧伤患者三重酸碱平衡紊乱124例回顾性分析

目的探讨烧伤患者三重酸碱平衡紊乱的临床特征与治疗方法。方法回顾性分析我科自1998-01～2004-04发生三重酸碱平衡紊乱的烧伤患者124例,其中呼碱+代酸+代碱85例,呼酸+代酸+代碱39例。所有患者均予祛除原发失衡病因、根据血pH情况补酸补碱、限碱、纠正电解质紊乱等治疗。结果复查血气分析纠正率89.5%,死亡率9.7%。结论休克、吸入性损伤、脓毒症是烧伤患者发生三重酸碱失衡的主要原因。临床以呼碱型三重酸碱失衡多见,呼酸型三重酸碱失衡则大多伴有吸入性损伤。烧伤合并三重酸碱失衡往往缺乏典型临床表现,死亡率较低。及时祛除引起原发失衡的病因是治疗的关键。     

新生儿酸碱平衡紊乱误诊及预后分析

目的：分析新生儿酸碱平衡紊乱特点及预后，漏诊、误诊原因，探讨其防治措施。方法：回顾性分析108例新生儿酸碱失衡的诊断，与入院诊断比较。结果：新生儿混合型酸碱失衡45．1％，三重酸碱失衡11．9％。酸碱失衡漏诊率5796，误诊率16％，其中混合型漏诊率89％，三重型漏诊率96％。患儿死亡率25．9％，三重型和混合型酸碱失衡死亡率明显高于单纯型酸碱失衡。结论：新生儿以混合型酸碱失衡为主，其中以呼酸合并代酸最常见，易漏诊、误诊而治疗不适当，三重型和混合型酸碱失衡预后不好。     

危重病儿酸碱失衡阴离子间隙在其诊断上的价值

对60例危重病儿进行微量血气监测并观察其中33例阴离子间隙的变化,结果表明酸碱代谢紊乱是个突出的问题,而酸中毒又占首位,纠酸是必要的,但要避免医源性碱中毒。阴离子间隙在诊断性酸碱失衡中有特别重要的作用,这是单用常规血气或者血清电解质测定所无法替代的。     

危重病儿酸碱失衡及阴离子间隙在其诊断上的价值

对60例危重病儿进行微量血气监测并观察其中33例阴离子间隙的变化，结果表明酸碱代谢紊乱是个突出问题，而酸中毒又占首位，纠酸是必要的，但要避免医源性碱中毒。阴离子间隙在诊断复杂性酸碱失衡中有特别重要的作用，这是单用常规血气或血清电解压测定所无法替代的。     

以阴离子间隙为线索筛选诊断酸碱失衡

酸碱平衡紊乱包括单纯型和混合型，其诊断方法十分复杂。近年来，阴离子间隙(AG)在酸碱失衡(尤为三重酸碱失衡)的诊断中的价值，越来越受到人们重视，献也报道丁许多酸碱失衡诊断方法。现将其综述如下。     

重症监护86例新生儿血气及阴离子间隙状态分析和临床意义

目的　探讨新生儿重症监护室 (NICU)中新生儿血液酸碱失衡和阴离子间隙 (AG)的特点。方法　对NICU中 86例新生儿进行血气分析、血电解质测定及AG测定。应用单纯性酸碱失衡代偿预期公式判断混合性酸碱失衡。对AG和血气的关系进行t检验。结果　 83例 ( 96 5 1% )存在酸碱紊乱 ,其中以代谢性酸中毒合并呼吸性酸中毒为最多见 ( 6 1 6 3% )。本组未见三重酸碱紊乱的病例。高AG4 9例 ( 5 6 98% ) ,为新生儿特点。AG与血气关系显示 ,高AG组与正常AG组的血液pH、氧分压 (PO2 )、氧饱和度 (SO2 )之间差异无显著性 (P >0 0 5 ) ,而与二氧化碳分压 (PCO2 )差异有显著性 (P <0 0 5 ) ,与剩余碱 (BE)、碳酸氢根 (HCO3 ) -差异有高度显著性 (P <0 0 1) 。结论　NICU中新生儿以代谢性酸中毒合并呼吸性酸中毒为最多见。危重新生儿存在高AG现象 ,对高AG酸中毒应以综合治疗     

新生儿窒息后肾损害的阴离子间隙分析

目的分析窒息后肾功能损害新生儿的阴离子间隙(AG)变化及其与肾损害的关系。方法首先测定151例窒息新生儿的血尿素氮(BUN)、肌酐(Cr)、电解质、动脉血气分析;然后,从中选取肾损害新生儿60例,并同时测定30例正常足月儿的上述指标,计算AG值并分析。结果窒息后肾损害的60例新生儿,代谢性酸中毒发生率为76.7%,且以高AG代酸为主,随窒息程度的加重,BUN、Cr无明显变化。结论窒息后肾功能损害新生儿血AG值可明显异常,需及时处理,BUN、Cr不能早期反映新生儿肾损害。     

高胆红素血症早产儿血清阴离子隙分析的意义

目的 探讨早产儿高胆红素血症(下称高胆)患儿的阴离子隙(AG)变化,为治疗提供依据.方法 测定94例高胆早产儿血清电解质、肾功能、肝功能,计算AG值,其中36例同时做动脉血气分折.结果 高AG44例(46.81％),正常AG 44例(46.81％),低AG 6例(6.38％).AG增高与血Na+浓度成正比,与HCO3-呈反比.AG与血清尿素氮(BUN)、肌酐(Scr)无相关性.结论 高胆早产儿高AG代谢性酸中毒发生率高,应常规测定血电解质、肾功能及动脉血气,计算AG值以指导治疗,以免盲目用碱纠酸.     

Pretreatment with human serum butyrylcholinesterase alone prevents cardiac abnormalities,seizures, and death in Göttingen minipigs exposed to sarin vapor

Human serum butyrylcholinesterase (Hu BChE) is a stoichiometric bioscavenger that is being developed as a prophylactic countermeasure against organophosphorus nerve agents. This study was designed to evaluate the efficacy of Hu BChE against whole-body inhalation exposure to a lethal dose of sarin (GB) vapor. Male Göttingen minipigs were subjected to: air exposure, GB vapor exposure, or pretreatment with Hu BChE followed by GB vapor exposure. Hu BChE was administered by i.m. injection 24 h prior to exposure to 4.1 mg/m³ of GB vapor for 60 min. Electrocardiograms (ECG), electroencephalograms (EEG), and pupil size were recorded throughout exposure. Blood drawn before and throughout exposure was analyzed for blood gases, electrolytes, metabolites, acetylcholinesterase and BChE activities, and amount of GB present. Untreated animals exposed to GB vapor exhibited cardiac abnormalities and generalized seizures, ultimately succumbing to respiratory failure. Pretreatment with 3.0 or 6.5 mg/kg of Hu BChE delayed blood gas and acid–base disturbances and the onset of cardiac and neural toxic signs, but failed to increase survivability. Pretreatment with 7.5 mg/kg of Hu BChE, however, completely prevented toxic signs, with blood chemistry and ECG and EEG parameters indistinguishable from control during and after GB exposure. GB bound in plasma was 200-fold higher than plasma from pigs that did not receive Hu BChE, suggesting that Hu BChE scavenged GB in blood and prevented it from reaching other tissues. Thus, prophylaxis with Hu BChE alone not only increased survivability, but also prevented cardiac abnormalities and neural toxicity in minipigs exposed to a lethal dose of GB vapor.     

中风患者血脑脊液酸碱气体分析

目的　探讨中风患者血、脑脊液酸碱气体的变化 ,为临床诊疗中风提供依据。方法　用血气分析仪对 96例中风患者做了血和脑脊液酸碱气体分析。将中经络组、中脏腑组分别与 5 0例正常组和 5 0例对照组进行比较。结果　中风患者的血和脑脊液中PO2 均降低 ,以中经络组血PO2 降低更明显 (P <0 0 1)。中风患者脑脊液中CH增高显示代谢酸中毒 ,以中脏腑组更为明显 (P <0 0 1)。结论　血和脑脊液酸碱气体分析可为中风病的诊断、治疗和预后判断提供客观依据。     

Safety of dietary conjugated α-linolenic acid (CLNA) in a neonatal pig model

The aim of the present study was to perform a short-term safety evaluation of dietary mono-conjugated α-linolenic acid isomers (CLNA; c9-t11-c15-18:3 + c9-t13-c15-18:3) using a neonatal pig model. CLNA diet was compared with three other dietary fats: (1) conjugated linoleic acid (CLA; c9-t11-18:2 + t10-c12-18:2), (2) non-conjugated n-3 PUFA and (3) n-6 PUFA. Thirty-two piglets weaned at 3 weeks of age were distributed into four dietary groups. Diets were isoenergetic and food intake was controlled by a gastric tube. Mono-CLNA diet did not significantly change body or organ weight, carcass composition and most biochemical parameters including; glucose, cholesterol, triglycerides, creatinine, blood urea nitrogen, hepatic enzymes and electrolytes levels in blood (P ⩾ 0.09). Conversely, the n-3 PUFA composition of the brain, liver and heart decreased by 6–21% in the CLNA-fed group compared to animals fed nonconjugated n-3 PUFA (P < 0.01). Responses to dietary treatments were tissue-specific, with the liver and the brain being the most deprived in n-3 PUFA. Our results support that short-term intake of mono-CLNA is safe in neonatal pigs but n-3 PUFA reduction in tissues deserves to be further investigated before using long-term nutritional supplementation in pigs and other animal models and before moving to clinical trials.     

慢性肺源性心脏病患者阴离子隙测评分析

本文对102例肺心病患者同步做血气和电解质并根据公式:AG=[Na~+]-([Cl~-]+[HCO_3~-]进行阴离子隙测定。分析了本组病人酸碱失衡的发生率、类型,并重点讨论了复合性酸碱失衡和三重酸碱失衡情况以及阴离子隙对肺心病病人复合性酸碱失衡的诊断意义。     

Effects of a new maintenance fluid containing sodium acetate as the base component and electrolytes during renal biopsies in patients with chronic glomerulonephritis

A new maintenance fluid containing sodium acetate as the base component and electrolytes (Veen 3G, test preparation) for a maximum of 24 h was infused to 15 patients hospitalized for renal biopsies and requiring intravenous supplements of water, electrolytes and energy because oral or enteric ingestion was inadequate or impossible. A physical examination, blood chemistry tests and urinalysis were performed, and the global improvement rating was obtained by scoring the effects on a) maintenance of cardiovascular hemodynamics (systolic blood pressure), b) blood glucose control (blood glucose level), c) utilization of sugar (free fatty acids, total ketone bodies), d) maintenance of serum electrolytes, e) amount of sugar excreted in the urine and f) maintenance of urinary volume. The results were excellent or good in all of the 15 patients analyzed. The test agent was not the direct cause of any adverse events or abnormal changes in laboratory findings, and no safety-related problems were observed in any of the patients. These results indicated that the test preparation used in this study is a clinically useful and highly safe fluid agent.     

The effect of E. coli STa enterotoxin on the absorption of weakly dissociable drugs from rat proximal jejunum in vivo.

1. The effect of E. coli heat stable (STa) enterotoxin on the absorption of radio-labelled weak electrolytes and their appearance in peripheral blood was assessed in vivo by use of an intestinal recirculation procedure. 2. STa reduced the luminal disappearance (P less than 0.02) and peripheral blood appearance (P less than 0.02) of label from salicylic acid as well as the luminal disappearance (P less than 0.02) of diphenylhydantoin. 3. In contrast, STa increased the appearance in peripheral blood and disappearance from the lumen of label from morphine (P less than 0.05), amphetamine (P less than 0.01) and lignocaine (P less than 0.01). 4. Increased weak base (lignocaine) absorption can also be achieved by a combination of forskolin and theophylline which resembles STa in its ability to neutralise the usually acid surface pH of the proximal jejunum. 5. Increased weak base absorption and hindered weak acid absorption occurs despite a uniform reduction in net fluid absorption after STs exposure, making it unlikely that variations in fluid absorption account for the variations in drug absorption. 6. The ability of STa to elevate the mucosal surface pH (or acid microclimate) to neutral values, thereby altering the proportion of uncharged weak-electrolyte, may explain its different effects on weak acids and bases: neutralisation of the acid microclimate would increase the amount of undissociate weak base available for uptake.     

1型糖尿病患儿自我血糖监测的调查现状分析

目的 提高1型糖尿病患儿的自我管理能力,延缓并发症的发生.方法 对110 例 1 型糖尿病患儿进行门诊及电话随访6个月,采用血糖自我管理日记收集资料.结果 每个月最多仅 4 例患儿能做到每天进行自我血糖监测,月监测血糖总例次数由第 1 个月的1613例次下降为第6个月的544 例次;3 个月及6个月糖化血红蛋白均值分别为(8.69±1.65)%及(8.23±1.92)%;患儿月血糖监测次数与家庭月收入、父母学历呈正相关(P< 0.01),与患儿年龄呈负相关(P< 0.01).结论 1 型糖尿病患儿出院后血糖自我监测状况不理想,其可能的相关因素为父母教育水平低,家庭月收入不佳所导致的对疾病治疗的理解力较差,再加上青春期患儿的逆反或自卑心理.