慢性阻塞性肺病呼吸衰竭机械通气并发代谢性碱中毒20例临床分析

目的：探讨COPDⅡ型呼吸衰竭机械通气并发代谢性碱中毒的病因和治疗。预防的方法，方法：62例COPD急性发作期Ⅱ型呼吸衰竭行机械通气持续72h以上，其中20例并发代谢性碱中毒，对该组病例通气前，后24h,48h,72h进行血气及电解质测定并进行比较分析。结果：20例COPDⅡ型呼吸衰竭患者机械通气前有低锅 ，低氯存在，机械通气后CO2排出过快，pH值升高，出现不同程度的兴奋，躁动等碱中毒症状。结论：CO2排出过快及低钠，低氯是造成机械通气中代谢性碱中毒的原因，可容许高碳血酸症和及时补钠，氯是预防和治疗代谢性碱中毒的主要方法。

Ventilation Treatment of Complicated COPD Respiratory Failure Metabolic Alkalosis an Analysis of 20 Cases

Objective: To explore the etiology, treatment and preventive method in the second type respiratory failure of COPD with metabolic alkalosis during ventilation treatment. Methods: Ventilation continued more 72?hours during the acute outbreak of 2 type respiratory failure in 62?cases of COPD, complicated metabolic alkalosis in 20?cases. Measurement of the blood gases and electrolyte of all patients before MV, after 24?h, 48?h, 72?h, and then comparison and analysis. Results: In 20?cases, the symptoms of excitation mania and other alkalosis occurred due to hypochloride and hyponatrium before MV, expirating bicarbonate too rapidly resulted in pH value rising after MV. Conclusion: Bicarbonate expirated too rapidly and hypochloride, hyponatrium are the causes of metabolic alkaloses during MV. Permissive hypercapnia and timely supplying natrium and chloride are the main method of prevention and treatment of metabolic alkalosis.