阻塞性肺气肿所致的血气酸碱失衡类型及原因分析

目的 探讨阻塞性肺气肿所致的血气酸碱失衡类型及原因。方法 分析180例阻塞性肺气肿患者的血气酸碱结果,并结合电解质测定进行统计分析。结果 阻塞性肺气肿患者发生酸碱失衡的类型主要有呼吸性酸中毒（64．5％）、呼吸性酸中毒合并代谢性酸中毒（11．1％）、呼吸性酸中毒合并代谢性碱中毒（23．3％）、呼吸性酸中毒型代谢性酸中毒合并代谢性碱中毒（1．1％）。结论 呼吸性酸中毒是阻塞性肺气肿患者发生酸碱失衡的基本类型,当并存其他疾病或者临床治疗不当时,可在呼吸性酸中毒的基础上发生混合性酸碱失衡。     

酸碱血气分析的临床应用(续)

八、酸碱内稳失衡的类型(一)临床上把酸碱内稳失衡分为四大基本类型(1)呼吸性酸中毒;(2)呼吸性碱中毒;(3)非呼吸性(代谢性)酸中毒;(4)非呼吸性(表谢性)碱中毒;     

脑卒中病人血气变化的探讨

目的 :探讨脑卒中患者酸碱失衡的类型、原因与救治原则。方法 :对 134例经CT确诊的急诊或住院的脑卒中患者进行动脉血气分析 ,并在同一天抽取静脉血测血Na+ 、Cl-浓度 ,所测数值均按各型酸碱失衡预计代偿公式计算。结果 :134例共进行 2 10例次动脉血气分析 ,不同类型不同程度的酸碱失衡共 14 8例次 (占 70 48% ) ,其中单纯性酸碱失衡 79例次 (占 37 6 2 % ) ,二重酸碱失衡 6 0例次 ( 2 8 5 7% ) ,三重酸碱失衡 9例次 ( 4 2 9% )。结论 :脑卒中患者存在酸碱失衡 ,以代谢性酸中毒、代谢性酸中毒合并呼吸性酸中毒、呼吸性碱中毒最为常见。原则上以治疗原发病为基础 ,纠正原发酸碱失衡 ,维持水电解质平衡 ,使pH值恢复正常     

急性左心衰竭患者血气变化及酸碱失衡分析

目的:探讨急性左心衰竭患者酸碱失衡类型及临床意义。方法:回顾性分析急性左心衰竭患者303例首次动脉血气参数(pH、PaO2、PaCO2、HCO3-)、酸碱失衡类型和电解质资料。结果:303例患者动脉血氧分压(PaO2)<80mmHg(1mmHg=0.133kPa)者235例(78%);发生不同类型酸碱失衡255例(84%),最常见的为呼吸性碱中毒并代谢性酸中毒(呼碱代酸)[45例(15%)],单纯性酸碱失衡79例(26%),二重性酸碱失衡150例(50%),三重型酸碱失衡(TABD)26例(9%)。结论:急性左心衰竭患者常发生低氧血症和酸碱失衡,酸碱失衡类型与引起心衰的原发病、诱发心衰因素有关,代碱多为医源性因素引起,伴有心源性休克、感染时急性左心衰竭患者容易伴有代酸;严重代谢性酸中毒合并呼酸是病情严重的标志。     

呼吸系统

880100吕8呼吸衰场合并玻玻失衡及水电解质紊乱的砚寮匀护理/容玉乔/护士进修杂志一1987,2(6)。一16一18 经临床观察,呼衰引起的酸碱失衡主要为:呼吸性酸中毒、呼吸性酸中毒合并代谢性酸中毒。合并代谢性碱中毒、呼吸性碱中毒四种类型。针对病情复杂,症状互有交叉,不易区别何类特点,常需用血气分析来测定动脉血的PH值等,以协助诊断和提供治疗依据。酸碱失衡的护理:1、观察呼吸改变、神志、心血管、消化道变化。2、注意病人对各种治疗的反应,准确使用各类药物。3、采血技术须熟练准确。4、对并发低血钾、高血钾、低血钠等电解质紊乱者,首先…     

肺心病患者BE改变94例分析

碱剩余(BE)是临床血气分析中判断酸碱失衡的一个重要指标.一般认为BE负值增加为代谢性酸中毒.BE正值加大为代谢性碱中毒.不受呼吸因素影响.本文对94例肺心病患者的呼吸性酸中毒(呼酸)、代谢性碱中毒(代碱)、呼吸性酸中毒合并代谢性碱中毒(呼酸 代碱)共130例次血气检测中的BE值改变进行分析,就BE值改变的临床价值进行了初步探讨.1 资料和方法1.1 一般资料 94例均为住院病人.男70例,女24例.年龄31～87岁.平均64.75岁.1.2 方法 用国产康龄170型血气分析仪测定动脉血气,同步检测血清电解质,共130例次.将其结果按呼酸.呼酸 代碱、代碱分为相应的三个组,并对其BE值的改变进行对比分析.     

正常阴离子间隙代谢性酸中毒及代谢性碱中毒属性问题的探讨

目的分析正常阴离子间隙代谢性酸中毒及代谢性碱中毒的基本属性,探讨为正常阴离子间隙代谢性酸中毒及代谢性碱中毒重新定性的可行性,同时也为混合性酸碱失衡类型的系统划分提供理论依据,解决过去对某些混合性酸碱失衡类型划分认识不清而出现的问题。方法利用血Na＋与阴离子之间的等量关系、阴离子之间变化的特殊关系以及代谢性酸中毒与代谢性碱中毒的特征进行分析,并以正常阴离子间隙（AG）为例,探讨在没有AG升高和下降影响下的代谢性酸中毒及代谢性碱中毒的基本属性。结果正常AG型代谢性酸中毒的基本属性是高Cl-性的,而代谢性碱中毒的基本属性是低Cl-性的。文中提供的高Cl-性代谢性酸中毒与低Cl-性代谢性碱中毒的识别条件,有助于对高Cl-性代谢性酸中毒及低Cl-性代谢性碱中毒进行识别。结论 ＂正常AG型代谢性酸中毒＂实际上就是高Cl-性代谢性酸中毒,而低Cl-和低K＋性代谢性碱中毒实际上是一种酸碱失衡类型,即低Cl-性代谢性碱中毒。过去因定性不准确,造成了酸碱失衡类型划分上的混乱。     

急性脊髓损伤围急性呼吸窘迫综合征血气分析

目的　探讨动态血气监测对急性脊髓损伤围急性呼吸窘迫综合征 (ARDS)的早期诊断、治疗和预后的意义。方法　回顾分析我院 1995～ 2 0 0 0年急性脊髓损伤并发围ARDS患者 4 5例 180例次动脉血气分析、酸碱平衡紊乱类型。结果　① 4 5例中单纯呼吸性碱中毒 16例 ,呼吸性碱中毒并代谢性碱中毒 13例 ,呼吸性酸中毒并代谢性酸中毒 9例 ,呼吸性酸中毒7例 ,治愈组主要以呼吸性碱中毒、呼吸性碱中毒并代谢性碱中毒等类型多见 ,死亡组主要以呼吸性酸中毒以及呼吸性酸中毒并代谢性酸中毒等类型多见。②所有患者的PaO2 <6 0mmHg、氧合指数 <2 0 0mmHg。③ 4 5例患者中围手术期ARDS治愈 35例(77 78% ) ,死亡 10例 (2 2 2 2 % )。结论　通过对 4 5例围ARDS的血气分析 ,动态监测动脉血气和计算氧合指数对围ARDS诊断和治疗具有重要作用。     

肝性脑病预后影响因素的临床研究

目的 探讨酸碱平衡紊乱,血氨水平及肝脏储备功能对肝性脑病(HE)预后的影响.方法 用微量血气分析仪测定动脉血气参数,用同一标本测定血氨(NH3),用静脉血同步测定血钾(K+)、血钠(Na+)、血氯(Cl-).血气参数按各型酸碱失衡预计代偿公式计算,同时计算阴离子间隙(AG)和潜在的碳酸氢根(HC03-).肝脏储备功能按Child-Pugh评分分A级、B级、C级.结果 101例肝性脑病(HE)中均有酸碱平衡紊乱,以呼碱型酸碱紊乱为主,共74例,三重酸碱紊乱(TABD),呼吸性碱中毒合并代谢性酸中毒,呼吸性碱中毒合并代谢性碱中毒,不仅发病率高,病死率也高,分别为94.4%、81.8%、72.2%.血氨升高在碱中毒时升高明显.肝功能B、C级组死亡率明显高于A级组.结论 HE患者并发呼碱型酸碱紊乱病人死亡率高,碱中毒时血氨升高对HE预后有重要影响,同时二者又相互关联共同增加死亡率.同时HE的发生、发展与肝脏的储备功能密切相关.     

昆明地区慢性肺心病酸碱紊乱特征分析

目的 :探讨昆明地区慢性肺心病酸碱紊乱特点。方法 :对 4 5 0例次慢性肺心病按海平面标准和昆明地区正常血气参考值所提出的诊断依据进行对比分析。结果 :本地区慢性肺心病酸碱紊乱类型以单纯呼吸性酸中毒 ,呼吸性酸中毒并代谢性碱中毒 ,呼吸性酸中毒并代谢性酸中毒为主。结论 :建立不同海拔高度地区酸碱紊乱判断标准有助于对疾病的正确判断。     

慢性肺原性心脏病与三重型酸碱失衡

分析２９１例慢性肺原性心脏病患者，发现有三重型酸碱失衡２１例（占７．２％），其中呼吸性酸中毒（呼酸）＋代谢性酸中毒（代酸）＋代谢性碱中毒（代碱）１７例，呼碱＋代酸＋代碱４例，绝大部分患者为老年人及多器官损害患者，１６例有肾功能不全。本组资料提示三重型酸碱失衡时血气表现非常复杂，ＡＧ值明显增加（本组最低值为１６．８ｍｍｏｌ／Ｌ，最高值为３１．４ｍｍｏｌ／Ｌ，平均值为２４．１ｍｍｏｌ／Ｌ），呼酸型三重型酸碱失衡者的ｐＨ值偏低，呼碱型三重型酸碱失衡者的ｐＨ多偏高。作者提出：三重型酸碱失衡的治疗原则是维持ｐＨ值正常，兼顾三种原发失衡，对每一种失衡的治疗不能操之过急，治疗的关键在于治疗原发性疾病，避免医源性因素，尤其注意利尿剂、激素等的合理使用。     

Abnormalities in acid-base balance in the elderly]

Physiological decline in the ability to adjust acid-base balance and increase the incidence of diseases with aging, modifies pathophysiological and clinical features of acid-base disturbance in the elderly. Regulation of pH ultimately depends on the kidney and lung, however, the ability of the two organs is decreased with physiological aging. Moreover, the elderly are more prone to suffer from renal insufficiency and/or chronic obstructive pulmonary disease. Furthermore, medication with various drugs, such as diuretics, often affect the acid-base balance in the elderly. This paper describes the characteristics of the abnormalities in acid-base balance in the elderly, including metabolic acidosis and alkalosis, and respiratory acidosis and alkalosis.     

Acid-base disturbances in heart failure]

Disturbance in acid-base balance is commonly observed in patients with heart failure. The most common disturbance is metabolic alkalosis combined with hypokalemia, as a result of the excessive use of loop diuretics. Occasionary, hypoxia due to pulmonary edema stimulates ventilation, resulting in respiratory alkalosis. When pulmonary edema develops, carbon dioxide retention occurs, resulting in respiratory acidosis. Decreased tissue oxygen delivery may also produce lethal lactic acidosis. Compensatory mechanisms, coexistence of independent acid-base disorders and changes in electrolytes complicate acid-base balance in the individual patients. As acid-base disturbances have harmful effects on the cardiovascular system, precise diagnosis and proper treatment are highly important.     

肺心病病人438例刚入院时动脉血气结果的分析

对438例肺心病病人刚入院时的动脉血气进行分析.结果显示,慢性呼吸性酸中毒特别是失代偿性呼酸最为常见,共235例,占53.65%,其余依次为慢性呼酸并代酸、慢性呼喊并代碱、慢性呼碱及代酸.慢性呼酸并代酸最为严重,及时行动脉血气分析有助于临床诊治.     

Metabolic alkalosis in the critically ill

Metabolic alkalosis is the commonest form of acid-base disorder seen in critically ill patients. Although the effects of acidosis have long been known, those of severe metabolic alkalosis are only slowly being recognized. Metabolic alkalosis is itself associated with an increased mortality and a knowledge of the causative factors and treatment options is important. In one study, around 50% of general surgical patients developed postoperative metabolic alkalosis, whereas other acid-base disturbances were uncommon. Metabolic alkalosis results from an accumulation of alkali or a loss of acid. Clinical signs are nonspecific but dehydration may be prominent because of a contraction of the extracellular fluid volume due to loss of chloride. Metabolic alkalosis leads to hypoventilation in patients both with and without lung disease, although in the latter, the effect is relatively transient. In patients with chronic obstructive lung disease, however, the development of metabolic alkalosis leads to prolonged hypoventilation and the establishment of a mixed acid-base disorder that may cause difficulty in weaning in the ventilated patient. This is an often forgotten cause of prolonged stay in the intensive care unit with consequent cost and morbidity implications.     

Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation

In metabolic alkalosis, a compensatory decrease in alveolar ventilation with hypercapnia has been noted only rarely. We recently managed a patient with gastric outlet obstruction from a duodenal ulcer who survived after arriving in the emergency room comatose with severe hypochloremic metabolic alkalosis, compensatory hypoventilation, and hypercapnia. We know of no report in the English literature of a patient with gastric outlet obstruction having a respiratory acidosis or hypochloremia as severe as that in our patient. Proper understanding of the pathophysiology of primary metabolic alkalosis due to gastric losses is necessary to correct the acid-base abnormalities quickly and to restore normal alveolar ventilation.     

Effects of acid-base abnormalities on blood capacity of transporting CO(2): adverse effect of metabolic acidosis

OBJECTIVE:To investigate the effects of some acid-base abnormalities on blood capacity of transporting CO(2).DESIGN: Prospective study.SETTING: General and Cardiosurgical ICUs of a University hospital.PATIENTS: Six groups of ten patients characterized by: metabolic alkalosis; respiratory alkalosis; absence of acid-base abnormalities; metabolic acidosis; uncompensated respiratory acidosis; and compensated respiratory acidosis.MEASUREMENTS AND RESULTS: The CO(2) dissociation curve, Haldane effect, and the ratio Ra-v between Ca-vCO(2) and Pa-vCO(2) were calculated from arterial and mixed-venous blood gas analyses. The CO(2) dissociation curve was shifted upwards by metabolic alkalosis and compensated respiratory acidosis and downwards by metabolic acidosis. The slope of the curve was unaffected, but CO(2) transport not due to Haldane effect was significantly lower in respiratory acidosis since the slope was less steep at higher PCO(2) values. In comparison with controls, patients affected by metabolic acidosis showed lower Haldane effect values (0.18+/-0.15 vs 0.59+/-0.26 ml of CO(2) per ml of arterial-mixed venous O(2) content difference; P <.05) and Ra-v values (0.43+/-0.10 vs 0.84+/-0.17 ml of CO(2) transported by 100 ml of blood per Torr of arterial-mixed venous PCO(2) gradient; P <.05).CONCLUSIONS: Our findings suggest that acid-base abnormalities, particularly metabolic acidosis, markedly affect blood capacity of transporting CO(2) and may worsen tissue hypercarbia associated with hypoperfusion. However, because of possible errors due to small measurements and the assumptions of the method, in the future definitive clarification will require the construction of original CO(2) dissociation curves for each acid-base abnormality.     

创伤后多器官衰竭动脉血气监测的临床意义

报告了112例创伤后多器官衰竭（MOF）患者645例次动脉血气和血电解质测定结果。645例次血气分析中有620例次（96．1％）存在不同类型的酸碱失衡，其中单纯性酸碱紊乱264例次（42．6％），二重酸碱失衡260例次（41．9％），三重酸碱失衡96例次（15．5％）。MOF早期多为呼吸性碱中毒，并发低氧血症，随病情的加剧，可发生代谢性酸中毒，严重者可发生三重酸碱失衡。救治时，要针对治疗原发疾病和积极纠正脏器衰竭的同时，动态监测血气，同步测定血电解质，这对及时发现并纠正酸碱失衡与血电解质紊乱有重要意义。