心肺复苏期间酸碱失衡的研究进展

本文简述心肺复苏期间酸碱失衡的特点以及ＣＯ２超射和高碳酸血症的概念，产生机制及其诊职，期望有助于提高心肺复苏的诊治水平。     

肺心病并发酸碱失衡的诊治

肺心病的发病原因以慢性气道疾患并发阻塞性肺气肿为多见。若伴发急性呼吸道感染,易出现缺氧和二氧化碳潴留,最终导致呼吸衰竭。当机体发挥最大限度代偿能力仍不能保持体内酸碱平衡时,可发生各种不同类型的酸碱失衡及电解质紊乱。如不及时治疗,可有生命危险。目前,由于血气分析仪的广泛应用,可及时做出酸碱失衡的判断。由此,对症采取一定的治疗手段,降低了肺心病的病死率。1.酸碱失衡类型1.1　呼吸性酸中毒　是肺心病酸碱失衡的基本类型,多见于其急性加重期。主要原因有:1慢支并肺感染时,气道粘膜水肿、充血,分泌物增多,痰液粘稠、不易咳出,…     

慢性肺心病三重型酸碱失衡的诊断探讨

比较分析380例次慢性肺心病各种类型酸碱失衡,探讨三重型酸碱失衡(TABD)的特点。在分析阴离子间隙(AG)意义的基础上着重指出当R值(HCO_2~-+Cl~-)<121.12mmol/L时可诊断代酸。计算R值较计算AG有简便易行、干扰因素少、诊断率高的优点。     

阴离子间隙诊断酸碱失衡再评价

本文讨论阴离子间隙(AG)值增高与降低的原因和肺心病患者AG值变化的因素。并强调除AG显著增高可诊断代酸外,对其余变化必须结合临床综合判断。     

第十二讲重型肝炎水、电解质紊乱和酸碱失衡的诊断与治疗

肝脏是体内代谢最活跃的器官，在维持水电解质和酸碱平衡中也起到了一定的作用。重型肝炎时患者极易发生内环境紊乱，势必造成水电解质和酸碱代谢失衡。正确识别重型肝炎并发水电解质和酸碱代谢失衡发生规律并及时处理，保持内环境稳定，对改善患者的预后十分重要。     

78例慢性肺心病患者酸碱失衡分析

慢性肺原性心脏病（下简称肺心病）急性发作期常出现酸碱代谢失衡，其发生率达84％～99％［1］，且类型复杂，变化较大，如不及时纠正，将严重影响肺心病的疗效。为了提高对肺心病住院患者酸碱失衡的认识，现将我院1995年7月～1996年12月间住院的78例肺心病的血气（234例次）变化进行回顾分析，对某些问题加以探讨。对象和方法检查对象78例肺心病患者均为住院病人。肺心病的诊断符合1977年全国第二次肺心病专业会议制定的诊断标准。其中男性37例，年龄42-87岁，平均64．7岁；女性41例，年龄39-83岁，平均60．2岁。标本采集及检测方法血气标…     

重型病毒性肝炎酸碱失衡的诊治研究近况

重型病毒性肝炎(简称重肝)患者由于肝脏功能衰竭,各种肛代谢紊乱十分明显,致使机体内环境紊乱十分突出且复杂,加上医源性因素,极易发生酸碱失衡     

酸碱失衡的诊断及处理

在溶液中,凡能释放H~+的物质称为酸,凡能接受H~+的物质称为碱。酸中毒系指溶液向酸性变化的过程和状态,包括pH失偿(酸血症)和代偿(恢复正常)两种状态;碱中毒系指溶液向碱性变化的过程和状态,也包括pH失偿(碱血症)和代偿(恢复正常)两种状态。酸血症系指动脉血pH     

Blood gas and acid-base balance during cardiopulmonary resuscitation by intrathroacic and abdominal pressure variations

Summary The blood gases and acid-base balance in a modified cardiopulmonary resuscitation (CPR) technique, based on intrathoracic and abdominal pressure variations by means of circumferential chest and abdominal balloon inflation, were examined in seven mongrel dogs. CPR proceeded for pcriods lasting 30 min or more and was monitored by measurements of aortic and right ventricular pressures and carotid blood flow during the compression (artificial systole) and the relaxation phase (artificial diastole). The carotid blood flow was 21.7±7.8 (mean±SD) ml/min, which was 0.18±0.6 (mean±SD) of the baseline mean carotid flow. Arterial blood was well oxygenated throughout the experiments, and low PCO₂ levels (5–9 mm Hg) caused an initial severe alkalosis (pH=7.94). However, a gradual decline in the pH was observed, reaching a value of 7.34±0.11 in the arterial blood after 30 min of CPR. The venous blood had a very low oxygen content (less than 25.5%) with a low PO₂ and a normal PCO₂ (43.7±7.3 mm Hg) throughout the experiment. A gradually developing metabolic acidosis was reflected in the pH values, and an increase in base deficit from 2.25±5.6 meq/1 prior to CPR to 16.7±3.2 meq/1 after 30 min of CPR was observed. High arteriovenous differences in oxygen content (greater than 66.4%) and CO₂ tension (30.1–41.5 mm Hg) with a slowly developing metabolic acidosis were noted. Thus, CPR by thoracic and abdominal pressure variations is associated with a slowly developing metabolic acidosis which is the result of the combination of hyperventilation and a low perfusion state.R. J. Matas-Winnipeg, Professor of Biomedical Engineering     

Intra-arterial monitoring during cardiopulmonary resuscitation

Because arterial cannulation assists in management of critically ill patients (pts), we assessed the utility of extending intra-arterial monitoring to hospitalized patients suffering in-hospital cardiopulmonary arrest outside of intensive care wards. A totally self-contained, readily portable system for rapid insertion of emergency intra-arterial lines was evaluated in 16 pts from 53 to 89 years old (mean = 66.5 years) undergoing cardiopulmonary resuscitation. Cannulation was successful in 14 pts (88% success rate). In 8 of 14 pts, cannulation was achieved rapidly and efficiently, whereas in six it was slightly delayed, once due to technical problems and five times due to difficulty cannulating the vessel. In addition to providing continuous pressure monitoring and ready access to arterial blood samples, direct feedback from the intra-arterial pressure waveform frequently led to improved compression technique by the resuscitator performing external cardiac massage. We conclude that under selected circumstances emergency intra-arterial monitoring has a potentially important adjuvant role during cardiopulmonary resuscitation.     

The value of echocardiography during cardiopulmonary resuscitation

Objective: To assess the contribution of echocardiography performed during cardiopulmonary resuscitation in the critically ill subject. Method: A retrospective review of all patients undergoing CPR and having an echocardiogram (transthoracic or transoesophageal) during resuscitation in a general intensive care unit at a medium-sized tertiary referral hospital was undertaken. Results: Eleven such patients were identified over a 48-month study period. In 4 patients, major changes were initiated as a result of the echocardiographic findings with 2 long-term survivors (14%). In another 5 patients the decision not to continue resuscitation was assisted by the findings. Conclusion: Echocardiography performed during CPR assists greatly in decision-making and can contribute significantly to survival.0