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。

Clincal significance of triple acid- base disorders in patients with severe viral hepatitis

To expore pathogenesis of triple acid-base disorders in patients with severe viral hepatitis and its clincal significance. The results of arterial blood gas analyses and electrolytes in 99 cases of severe viral hepatitis were evaluated with base on anion gap (AG) 21 cases were found to be complicated with triple acid-base disorders which were all TABD with respiratory alkalosis. The initial status of acid-base disorder in most of cases with TABD was primary respiratory alkalosis or metabolic alkalosis, developed into respiratory and metabolic alkalosis and finally came to TABD. The occurring rates of hepatorenal syndrome, hepatic encephalopathy, primary bacterial peritonitis and upper gastro-intestinal bleeding in the cases with TABD were higher than those of the cases with simple acid-base disorder and often had above two kinds of complications which were at the stages of fulminant hepatic failure. The study showed the occurrences of TABD in patients with severe viral hepatitis were associated with multiple organ damage and many other factors.