120例重症肺结核继发感染的酸碱失衡分析

目的 分析重症肺结核继发感染的酸碱失衡情况。方法 以ＡＢＬ－５０５血气电解质分析仪测定患者股动脉血,所得ｐＨ、ＰＣＯ２、ＨＣＰ３＾－值代入酸碱失衡预计偿公式,首先判断出单纯型或混合型酸碱失衡,然后根据阴离子间隙判断有无三重酸碱失衡。结果 到碱失衡发生率,单纯型〉混合型〉三重酸碱失衡;呼酸型〉呼碱型,代酸与代碱基本相当;通过控制感染,酸碱失衡得到明显纠正。结论 重症肺结核继发感染可使肺组织严重破坏,     

传染性非典型肺炎159例酸碱平衡与临床分型及病程关系分析

目的探讨各型严重急性呼吸综合征每周的酸碱失衡情况及其规律。方法159例患者，住院后每周测定血气分析，每位患者每周只取一次血气结果，共得血气分析结果430例次，分周分型进行统计。结果发病前2周，普通型和重型患者酸碱失衡以代碱呼碱为主；而极重型以呼碱代酸为主；极重型患者第1周呼碱型三重失衡比例较多，仅次于呼碱加代酸位居第二位：第3周后，普通型患者单纯代碱的比例迅速上升并跃居首位，而重型患者则虽也上升但相对较慢，代碱呼碱仍处于首位，极重型则代碱呼碱比例上升为首位；代碱代酸而同时不合并呼吸性酸碱失衡者仅在普通型存在；呼酸比例在普通型中从第2周逐渐增多，至第5周出现高峰。结论患者病程2周内出现呼碱代酸或呼碱型三重酸碱失衡，应高度警惕发展为极重型的可能，积极加强治疗；出现单纯的代碱或排除气道阻塞、呼吸肌疲劳及机械通气因素造成的呼酸，以及呼碱消失，可能预示着病情开始恢复；应用某些药物时要随时注意酸碱失衡，及时调整或纠正；应用机械通气要着重对呼碱因素进行治疗，合理调整压力水平。     

酸碱失衡类型系统划分及划分视图设计

酸碱失衡类型划分在不断完善。传统的酸碱失衡类型仅有：代谢性酸中毒（代酸）、代谢性碱中毒（代碱）、呼吸性酸中毒（呼酸）、呼吸性碱中毒（呼碱）、呼酸并代酸、呼酸并代碱、呼碱并代酸、呼碱并代碱八型。随着阴离子间隙（anion gap,AG）和潜在HCO3^-（potential bicarbonate）概念在酸碱失衡领域中的应用,人们又提出了几种新的酸碱失衡类型：①高Cl-性代酸并高AG代酸;②代碱并高AG代酸;③三重酸碱失衡（triple acid—base disturbance,TABD）,包括呼酸＋代碱＋高AG代酸（呼酸型TABD）和呼碱＋代碱＋高AG代酸（呼碱型TABD）两型。     

混合型酸碱平衡紊乱的进展

混合型酸碱平衡紊乱(mixed acid basedisturbances)在临床上并不少见,常发生于严重复杂疾病中,也可因治疗措施不当而促成。混合型酸碱平衡乱紊(简称混合型酸碱失衡)是指病人同时存在两种或两种以上单纯型酸碱平衡紊乱(简称单纯型酸碱失衡)。单纯型酸碱失衡中代谢性酸中毒(简称代酸)、代谢性碱中毒(简称代碱)、呼吸性酸中毒(简称呼酸)和呼吸性碱中毒(简称呼碱)可分别相互组合。     

关于呼酸和呼碱同时存在的探讨——对“呼吸性酸中毒并呼吸性碱中毒性酸碱紊乱”一文的商榷

酸碱紊乱有四个基本类型即呼酸、呼碱、代酸、代碱,目前多数意见只能有三种类型同时存在,即呼酸和代酸,代碱并存称为呼酸型三重酸碱失衡(TABD);呼碱和代酸,代碱并存称为呼碱型TABD 但呼酸和呼碱不能同时并存,为此不可能有呼酸、呼碱、代酸、代碱     

呼吸衰竭时的酸碱失衡及其临床意义

呼吸衰竭时常因缺氧和（或）CO2潴留,并发酸碱失衡。常见的异常动脉血气及酸碱失衡类型是：①严重缺氧伴有呼酸;②严重缺氧伴有呼酸并代碱;③严重缺氧伴有呼酸并代酸;④缺氧伴有呼碱;⑤缺氧伴有呼碱并代碱;⑥缺氧伴有三重酸碱失衡（TABD）。一、严重缺氧伴有呼酸Ⅱ型呼吸衰竭患者因缺氧和CO2潴留同时存在,常可表现为严重缺氧伴有呼酸。1．动脉血气和血电解质变化特点：①动脉血二氧化碳分压（PaCO2）原发性升高;②HCO-3代偿性升高,但慢性呼酸必须符合预计Hny二24＋0．35xdPaAn02t5．58范围内;急性呼酸H仰＜刀11ill－c,ir…     

重型病毒性肝炎并发三重酸碱失衡及其临床意义

探讨重型病毒性肝炎合并三重酸碱失衡的发病机理及其临床意义。用阴离子间隙（AG）概念，对99例重型肝炎患者血气分析和血电解质检查进行分析。有21例（21．2％）呈三重酸碱失衡(TABD），均为呼碱型（呼碱＋代碱＋代酸），大多数由原发呼碱或代碱转为呼碱合并代碱，最后发展为TABD。比较发现，合并TABD患者其肝肾综合征、肝性脑病、自发性细菌性腹膜炎和上消化道出血的发生率显著高于单纯酸碱失衡患者，且常合并两种以上并发症处在重型肝炎病程的晚期。重型肝炎患者合并TABD是多脏器损害和多因素作用的结果。     

完善三重酸碱失衡判断方法

目的分析目前临床上在三重酸碱失衡判断中存在的问题,完善判断方法。方法采用归拿整理的方式,将作者最近提出的各种酸碱失衡判断方法及公式相结合,用于三重酸碱失衡的判断。结果新的判断方法简单实用,可准确地判断三重酸碱失衡。结论三重酸碱失衡中的代碱及高AG代酸,原判断方法选用不当,本该用作高AG代酸判断的潜在HCO_3^-概念,被用在了代碱的补充判断上,使两者都存在误判现象,判断方法需要改进。     

重型病毒性肝炎酸碱失衡的正确判断——运用潜在HCO_3~-及阴离子隙的意义

为了正确判断重型病毒性肝炎患者酸碱失衡(ABD),联合运用ABD预计代偿公式、阴离子隙(AG)和潜在HCO_3~-,分析了244例次血气分析和电解质测定参数。仅用预计代偿公式判断,131例次为单纯ABD(53.7%),113例次为二重ABD(46.3%);加用AG分析使47例次单纯ABD改判为二重ABD,19例次二重ABD判为三重ABD;再加用潜在HCO_3~-分析,三重ABD由19例次(7.8%)增至97例次(32.4%)。重肝ABD以呼碱、呼碱并代碱及呼碱代酸并代碱为常见。碱血症与酸血症之比为2.26:1。三ABD患者并发症率及病死率均明显高于单纯ABD。提示潜在HCO_3~-及AG对正确判断混合ABD尤其是三重ABD有重要价值,ABD对预后判断有一定价值。     

三种不同方法对三重酸碱紊乱判定的比较

三种不同方法对三重酸碱紊乱判定的比较罗炎杰，肖欣荣三重酸碱紊乱（ＴＡＢＤ）是指一种呼吸性酸碱紊乱合并高阴离子间隙（ＡＧ）代酸或代碱，其中呼酸＋代酸＋代碱者为呼酸型ＴＡＢＤ，呼碱＋代酸＋代碱者为呼碱型ＴＡＢＤ。目前判定ＴＡＢＤ的方法尚不一致，判定结果差...     

慢性肝衰竭和失代偿期肝硬化患者血气分析的变化

目的探讨慢性肝衰竭和失代偿期肝硬化患者血气分析变化的临床意义。方法回顾性分析我科收治的37例慢性肝衰竭和失代偿期肝硬化患者的血气分析资料。结果2例患者出现明显的缺氧表现,4例患者出现立位性缺氧表现,11例患者感轻度胸闷;在36例存在酸碱失衡的患者,慢性肝衰竭组存在单纯酸碱失衡9例,两重酸碱失衡10例,三重酸碱失衡2例,失代偿期肝硬化组存在单纯酸碱失衡8例,两重酸碱失衡7例。两组患者在酸碱失衡的类型方面无统计学差异;两组均以碱中毒为主。慢性肝衰竭组中比例较高的三种类型依次为呼吸性碱中毒合并代谢性酸中毒（38．1％）、呼吸性碱中毒（23．8％）和代谢性碱中毒（14．3％）,单纯性代谢性酸中毒比例最低（4．8％）。失代偿期肝硬化组中比例较高的三种类型依次为呼吸陛碱中毒（46．7％）、呼吸性碱中毒合并代谢性碱中毒（26．7％）和呼吸性碱中毒合并代谢性酸中毒（20．0％）,代谢性碱中毒比例最低（6．7％）。结论慢性肝衰竭和失代偿期肝硬化患者存在酸碱失衡和低氧血症,动态监测血气分析并及时对症治疗对此类患眷具有重要的临床意义。     

结核病医院院内下呼吸道感染的临床调查分析

目的 了解肺结核病人院内下呼吸道感染的临床流行情况及其相关危险因素?方法 对 1.998年 1月～ 1.999年 1 2月实际出院的肺结核病人中符合院内下呼吸道感染者逐一填写医院感染病例登记表 ,对表内资料进行回顾性分析?结果 1 肺结核病人院内下呼吸道感染发生率 4 .9%?高危人群为伴有慢性肺部疾患的老年人?肺部以纤维空洞?支气管扩张?肺不张为主要病理损害的肺结核患者?相关危险因素为住院时间长?反复住院?重症结核病所致营养状态低下?大量长期使用广谱抗生素? 2 铜绿假单孢菌及克雷伯氏杆菌属是本院下呼吸道感染的主要致病菌 ,且合并真菌感染率高 ( 48.2 % )?结论 结核病人院内下呼吸道感染是一个值得关注的问题?     

慢性阻塞性肺疾病急性加重机械通气治疗后酸碱平衡状态及电解质的变化

目的 研究机械通气后代谢性碱中毒及电解质紊乱的发生状况,探讨恰当的处理方法,旨在提高慢性阻塞性肺疾病急性加重(AECOPD)机械通气技术的临床应用水平,并提高AECOPD抢救的成功率和改善慢性阻塞性肺疾病(COPD)患者的预后.方法 回顾性分析伴Ⅱ型呼吸衰竭的AECOPD并使用机械通气的患者62例,并分为无创通气(35例)和有创通气(27例)二组,观察比较二组患者使用机械通气前、机械通气后1h、2h、3h、24 h、72 h及通气结束后的动脉血气及Na+、K+、Ca2+变化.结果 二组患者使用机械通气后呼吸性酸中毒明显改善.无创通气组通气3h时出现6例失代偿期碱中毒(17.14％),通气72 h后有22例(62.86％)患者出现代谢性碱中毒(包括代偿期和失代偿期),其中失代偿期碱中毒7例(25.93％),达碱中毒高峰.有创通气组在通气2h出现7例失代偿期碱中毒(25.93％),通气3h后即出现21例(77.77％)代谢性碱中毒,其中失代偿期碱中毒9例(33.33％).二组在通气前Na+低于正常,且K+高于正常值,通气结束后恢复正常.比较24h时碱中毒者与无酸碱平衡紊乱者的电解质,发现碱中毒者K+、Ca2+低于无酸碱紊乱者.结论 机械通气用于治疗伴Ⅱ型呼吸衰竭的AECOPD患者疗效肯定.机械通气后由于二氧化碳排出过快往往导致高碳酸血症呼出后代谢性碱中毒的发生,同时引起电解质钾、钙的降低.有创机械通气较无创机械通气代谢性碱中毒出现早.     

Acid-base disorders in hyperglycemia of insulin-dependent diabetic patients on chronic dialysis

The authors studied hyperglycemia occurring in insulin-dependent diabetic patients on chronic dialysis to determine the types of associated acid-base disorders, their treatment, and any differences from hyperglycemia in diabetic patients with intact renal function. Eighty-eight episodes of serum glucose greater than 25 mmol/L were observed, 23 in hemodialysis patients and 65 in patients on continuous peritoneal dialysis. Treatment consisted of low-dose insulin in 77 episodes and low-dose insulin plus saline in 11; no base was administered. Seventeen episodes (19%) presented with ketoacidosis. Arterial blood gas determinations were carried out at presentation in 37 of the episodes without ketoacidosis. Of these, 12 had respiratory alkalosis, six had respiratory acidosis and severe pulmonary edema, 14 had other single or mixed acid-base disorders, and only five had normal acid-base status. Insulin corrected the ketoacidosis in all instances and both pulmonary edema and respiratory acidosis in five of six instances. In eight cases metabolic alkalosis developed during treatment, without external acid loss. At the completion of treatment respiratory alkalosis was present in half the cases. No difference was noted between patients treated with hemodialysis or peritoneal dialysis. Insulin alone is sufficient for the management of hyperglycemia in dialysis patients. Certain acid-base disorders persist, but do not need further treatment. Hyperglycemia in patients on dialysis is characterized by infrequent development of metabolic acidosis and frequent presentation with respiratory alkalosis, by respiratory acidosis that is corrected by insulin, and by metabolic alkalosis developing during treatment without external cause.     

Equilibrium of acidifying and alkalinizing metabolic acid-base disorders in cirrhosis.

BACKGROUND AND AIMS: Conflicting results exist with regard to metabolic acid-base status in liver cirrhosis, when the classic concept of acid-base analysis is applied. The influence of the common disturbances of water, electrolytes and albumin on acid-base status in cirrhosis has not been studied. The aim of this study was to clarify acid-base status in cirrhotic patients by analyzing all parameters with possible impact on acid-base equilibrium. PATIENTS AND METHODS: Fifty stable cirrhotic patients admitted to a university hospital. Arterial acid-base status was analyzed using the principles of physical chemistry and compared with 10 healthy controls. RESULTS: Apart from mild hypoalbuminemic alkalosis, acid-base state was normal in Child-Pugh A cirrhosis. Respiratory alkalosis was the net acid-base disorder in Child-Pugh B and C cirrhosis with a normal overall metabolic acid-base state (Base excess-1.0 (-3.6 to 1.6) vs 1.1 (-0.2 to 1.1) mmol/l, P = 0.136, compared with healthy controls, median (interquartile range)). Absence of an apparent metabolic acid-base disorder was based on an equilibrium of hypoalbuminemic alkalosis and of dilutional acidosis and hyperchloremic acidosis. CONCLUSION: A balance of offsetting acidifying and alkalinizing metabolic acid-base disorders leaves the net metabolic acid-base status unchanged in cirrhosis.     

慢性阻塞性肺病并发急性呼吸衰竭的危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)并发急性呼吸衰竭的相关危险因素及预后因素,为临床防治策略的制定提供参考依据。方法选取我院呼吸内科收治的COPD患者148例,根据是否有并发急性呼吸衰竭分为急性呼衰组52例和非急性呼衰组96例。根据急性呼衰组患者的转归情况,将其分为好转组36例以及死亡组16例。分析慢性阻塞性肺疾病并发急性呼吸衰竭的危险因素,并研究急性呼吸衰竭预后的相关因素。结果每年发生慢性阻塞性肺病急性发作次数多、尿酸水平低、白蛋白水平低、消瘦、发生医院感染、未使用吸入用糖皮质激素、酸碱失衡是COPD致急性呼吸衰竭的危险因素;而酸碱值低、血二氧化碳分压升高、血清钠降低、血清氯低、医院感染、并发肺性脑病、并发心功能衰竭是COPD并发急性呼吸衰竭患者预后的危险因素。结论慢性阻塞性肺疾病并发急性呼吸衰竭与COPD发作的次数、机体营养状况、电解质酸碱失衡、医院感染的发生、吸入用糖皮质激素的使用等多个危险因素有关。     

Arterial and mixed venous acid-base status in patients with cirrhosis. Influence of liver failure

ABSTRACT— Although it has been established that liver failure is associated with arterial hypocapnia and alkalaemia (i.e., respiratory alkalosis), the influence of liver failure on mixed venous acid-base status has not yet been studied. Thus, arterial and mixed venous acid-base status were simultaneously measured in controls and in a large series of patients with cirrhosis. Grade B patients (n = 28) or Grade C patients (n = 21) had significantly lower arterial and mixed venous carbon dioxide tensions than controls (n = 29). Grade B or Grade C patients also had significantly higher arterial, mixed venous pH, and lower mixed venous bicarbonate concentrations than controls. Among Grade A patients (n = 27), those with the lowest Pugh's score (i.e., equal to five) had significantly lower mixed venous carbon dioxide tension than controls. The other arterial and mixed venous acid-base values did not differ significantly between Grade A patients with the lowest Pugh's score and controls. Grade A patients with a Pugh's score equal to six and Grade B patients had similar acid-base disorders. No significant differences were found between groups concerning the anion gap and plasma chloride concentrations. In conclusion, this study shows that in Grade B or C patients, respiratory alkalosis was responsible for mixed venous hypocapnia, alkalaemia and hypobicar-bonataemia. In addition, in Grade A patients with the lowest Pugh's score (equal to five), analysis of arterial and mixed venous blood revealed that mixed venous hypocapnia was the sole anomaly of the acid-base status. This last finding suggests that mixed venous hypocapnia might be an early event preceding the onset of arterial hypocapnia.     

Acid-base state and blood oxygenation in cardiac insufficiency treated by drug agents]

The effect of different drugs on the acid-base condition and gases of arterial blood was studied by Astrup's micromethod in 124 tests in patients with circulatory insufficiency. Cardiac glycosides correct the moderate decrease in blood oxygen tension and respiratory alkalosis in patients with left-ventricular failure. Morphine has a good arresting effect in attacks of cardiac asthma and corrects or reduces the respiratory alkalosis typical of the disease but at the same time reduces the saturation of blood with oxygen. The use of oxygen together with morphine removes this unfavourable effect of the drugs. Euphylline often intensifies respiratory alkalosis, while its effect on oxygen tension in the blood and its saturation with oxygen is poorly pronounced and diversely directed. Lasics causes a favourable correcting effect on the acid-base condition and oxygenation of blood in pulmonary edema marked by metabolic acidosis.     

COPD呼衰肺心病心衰并酸碱失衡及水和电解质紊乱分析

目的探讨COPD呼吸衰竭合并肺心病心衰患者发生酸碱平衡紊乱及水电解质失衡的病因及治疗的重要性。方法 68例COPD呼衰合并肺心病心衰住院患者,对其入院时及治疗过程的检验结果进行统计分析,观察其酸碱失衡及水电介质紊乱发生原因及情况。结果 68例患者发生酸碱失衡及水电介质紊乱概率为97.2%。结论 COPD呼衰合并肺心病心衰病人易发生酸碱失衡及水电介质紊乱,在治疗原发病的基础上,密切监测酸碱、水电解质情况,保持其平衡在临床治疗中意义重大。