呼吸心搏骤停初期血液酸碱状态及碱性药物的应用  

Acid-base status in early period of respiratory andcardiac arrest and use of alkaline drug

作　　者：张成林[1] 傅锡林 李芳琳[1] 

机构地区：[1]广州军区广州总医院急诊科,广州军区广州总医院麻醉科

出　　处：《中国危重病急救医学》1994年第2期85-88,共4页Chinese Critical Care Medicine

摘　　要：本资料显示急性及慢性病呼吸心搏骤停初期均存在酸血症，其程度取决基础疾病。复苏中使用碳酸氢钠（ＳＢＣ）纠酸较适宜，有效通气及首次补给标准量ＳＢＣ后，急病组ｐＨ、ＰａＣＯ＿２，ＡＢ、ＢＥ有显著性改善，慢病组除ｐＨ、ＰａＣＯ＿２有改善外，ＡＢ、ＢＥ改善不显著（Ｐ＞０．０５），表明首次标准量ＳＢＣ对急病骤停者合理，慢病骤停者量偏小，ｐＨ７．２０～７．２５的初期复苏有效者急病组８２％，慢病组８０％，均高于问组ｐＨ＜７．２０或＞７．２５者。作者主张将ｐＨ值控制在７．２０～７．２５为宜。急病骤停者超过６ｍｉｎ未恢复自主呼吸循环，宜及时补以标准量ＳＢＣ，随后根据动脉血气分析追加，慢病骤停者应结合原发病分析，骤停前有酸血症倾向者，应及早给予标准量ＳＢＣ或适宜加大量，无必要快速完全予以纠正。This study showed that acidemia was seen in theearly period of respiratory and particularly cardiacarrest due to both acute and chronic diseases (groupof acute illness and group of chronic illness).The se-verity of acidemia depended on the underlying dis-eases.Use of sodium bicarbonate(SBC) was indicatedin the resuscitation.Marked.improvement(p<0.01)of various parameter (PH,PaCO_2,AB,BE)was seenin the group of acute illness after the efficient ventila-tion and the first administration of a standard doseof SBC.In the group of chronic illness,pH andPaCO_2 were significantly improved,but no markedimprovement of AB and BE was found(P>0.05).Thos Showed that the first standard dose of SBC wasappropriate for treating respiratory and cardiac ar-rest due to acute underlying diseases but seemed tobe inadequate for treating the arrest due to chronicunderlying diseases. The success rate of the primaryresuscitation was 82% in the group of acute illnessand 80%in the group of chronic illness when the pa-tients,pH was7.20-7.25.This result reflected that re-suscitation in patients with pH values being7.20-7.25 was mostly effective as compared with theother patients in the same group with pH values lessthan 7.20 or more than 7.25.Hence it is considered tobe appropriate to keep the pH values in the range of7.20-7.25.A standard dose of SBC should be given tothe patients with respiratory and cardiac arrest(lasting more than six minutes)due to acute underlyingdisease and a supplementary dose based on the arte-rial blood gas analysis is administered.A timelystandard dose or a properly increased dose of SBCshould be given to the patients with respiratory andcardiac arrest due to chronic underlying diseaseswhich have a tendency toward academia according tothe clinical analysis,but a dramatic and completecorrection of acidosis is unnecessary.

关 键 词：呼吸心搏骤停 酸碱平衡 碳酸氢钠 

分 类 号：R459.7[医药卫生—急诊医学]