合并两组酸碱失衡预计代偿公式的可行性研究

目的合并Hamm和Carroll单纯性酸碱平衡紊乱预计代偿公式,形成新的预计代偿公式,提高判断准确性。方法①计算Hamm及Carroll公式6种酸碱失衡预计代偿范围;②合并两组公式预计代偿范围：慢性呼吸性碱中毒（呼碱）时,合并预计最大代偿值=Hamm预计最大代偿值-0.200×（Hamm-Carroll）预计最大代偿值,慢性呼吸性酸中毒（呼酸）时,合并预计最大代偿值=Hamm预计最大代偿值＋0.125×（Carroll-Hamm）预计最大代偿值,慢性呼碱（酸）时,预计最小代偿值=（Hamm＋Carroll）预计最小代偿值/2,其他酸碱失衡预计最大（最小）代偿值的合并预计代偿值=（Hamm＋Carroll）预计代偿值/2;③用直线回归方程还原合并预计代偿公式;④软件模拟酸碱失衡数据,对3组公式判断的酸碱失衡类型进行Kappa一致性检验。结果新合并公式：代谢性酸中毒（代酸）PaCO2=（39.0-1.30×△[HCO3-]↓）～（41.0-1.10×△[HCO3-]↓）,代谢性碱中毒（代碱）PaCO2=（37.5＋0.65×△[HCO3-]↑）～（42.5＋0.90×△[HCO3-]↑）,急性呼酸[HCO3-]=（23.26＋0.046×△PaCO2↑）～（24.80＋0.120×△PaCO2↑）,慢性呼酸[HCO3-]=（22.50＋0.325×△PaCO2↑）～（25.50＋0.475×△PaCO2↑）,急性呼碱[HCO3-]=（22.75-0.225×△PaCO2↓）～（25.25-0.200×△PaCO2↓）,慢性呼碱[HCO3-]=（22.75-0.500×△PaCO2↓）～（25.25-0.450×△PaCO2↓）。结论合并公式与Hamm及Carroll公式配对的Kappa值及判断一致率,均明显高于Hamm与Carroll公式配对（P〈0.01）。合并公式可应用于临床。

A Feasibility Study of Combinating Two Sets of Formulae for Metabolic Acid-base Imbalance

Objective To assess blood gas analysis more accurately by combining Hamm＇and C arroll＇formulae for simple acid-base imbalance and forming new expected algorithms. Methods Firstly, the expected compensation ranges of six kinds of simple acid-base disorder were calculated respectively by Hamm＇and Carroll formulae; scecondly, the two sets of compensation ranges were combined： in chronic respiratory alkalosis, the combined max new compensation value = hamm＇smax value - 0. 200 × （harem＇s max value - Carroll＇s max value） ; in chronic respiratory acidosis, the combined max new compensation value = hamm＇s max value ＋ 0. 125 × （Carroll＇s max value - hamm＇s max value） , in chronic respiratory aikalosis （acidosis） , the combined rain new compensation value = （hamm＇s min value ＋ Carroll＇s min value）/2, in metabolic and acute respiratory acidosis （alkalosis） , the combined max （min） new compensation value = （hamm＇s value ＋ Carroll＇s value）/2; and the expected new algorithms were reverted by linear regression equation; Finally, model arterial blood gas analysis data generated by software were calculated by three algorithms, and Kappa con- sistency check were applied. Results The combined new algorithm was gained： metabolic acidosis： PaCO2 = （39.0 -1.30 ×△ [ HCO3 ]↓-） - （41.0 - 1.10△[ HCO3 - ↓]） ; metabolic alkalosis PaCO2 = （37.5 ＋0. 65 × △ [ HCO3↑] ） -（42.5 ＋0.90× △[HCO3↑ ）; acute respiratory acidosis [HCO3 ] = （23.26 ＋0.046 ×△PaCO2 ↑ ） （24.80 ＋0. 120 × △PaCO2 ↑ ） ; chronic respiratory acidosis [HCO3 - ] = （22.50 ＋ 0. 325 ×APaCO2 ↑ ） - （25.50 ＋ 0.475 × △PaCO2 ↑ ）; acute respiratory alkalosis [HCO3- ] = （22.75 -0.225 ×△PaCO2 ↓ ） - （25.25 -0.200 × PaCO2 ↓ ） ; chronic respiratory alkalosis [ HCO3 - ] = （22.75 - 0. 500× △PaCO2 ↓ ） - （25.25 - 0. 450 ×△PaCO2 ↓ ）. Conclusion The consistency between the combined algorithms and hamm or Carrollg is better than that between Hamm and Carrollg, and so does the Kappa value （P 〈0. 01）. The modified algorithms can be applied in practice.