慢性肺原性心脏病与三重型酸碱失衡  

Chronic cor pulmonale and triple acid- base disorders

作　　者：蒋军广[1] 王淑梅[1] 谭伟丽[1] 

机构地区：[1]河南医科大学第一附属医院

出　　处：《中国危重病急救医学》1995年第5期274-275,共2页Chinese Critical Care Medicine

摘　　要：分析２９１例慢性肺原性心脏病患者，发现有三重型酸碱失衡２１例（占７．２％），其中呼吸性酸中毒（呼酸）＋代谢性酸中毒（代酸）＋代谢性碱中毒（代碱）１７例，呼碱＋代酸＋代碱４例，绝大部分患者为老年人及多器官损害患者，１６例有肾功能不全。本组资料提示三重型酸碱失衡时血气表现非常复杂，ＡＧ值明显增加（本组最低值为１６．８ｍｍｏｌ／Ｌ，最高值为３１．４ｍｍｏｌ／Ｌ，平均值为２４．１ｍｍｏｌ／Ｌ），呼酸型三重型酸碱失衡者的ｐＨ值偏低，呼碱型三重型酸碱失衡者的ｐＨ多偏高。作者提出：三重型酸碱失衡的治疗原则是维持ｐＨ值正常，兼顾三种原发失衡，对每一种失衡的治疗不能操之过急，治疗的关键在于治疗原发性疾病，避免医源性因素，尤其注意利尿剂、激素等的合理使用。patients with chronic cor pulmonale were re-ported.Triple acid-base disorders were discovered in 21patients( 7.2%)amorig whom respiratory acidosis associ-ated with metabolic alkalosis and metabolic acidosis wasdiagnosed in 17 patients,and respiratory alkalosis associ-ated with metabolic alkalosis and metabolic acidosis in 4patients.Most of them were in the elderly and in the pa-tients with multiple organ injuries.Of the 21 patients, 16had renal failure. The data demonstrated that the mani-festation of blood gases in triple acid-base disorders wasvery complicated. The anion gap values were significantlyincreased , ranging from 16.8 to 31.4 mmol/L(average24.1 mmol/L). pH often tended to be acid in triple acid-base disorders with respiratory acidosis and alkalinewhile with respiratory alkalosis. The principles for treat-ment of triple acid-base disorders were discussed :a nor-mal pH should be maintained;consideration must be giv-en to all three kinds of the primary acid-base imba-lence;the treatment of each imbalance should not be giv-en with undue haste:the key to the treatment lies in thetreatment of the underlying disease; attention sboule bepaid to the avoidance of iatrogenic causes,and to the rea-sonabie use of diuretics and hormons in particular.

关 键 词：肺心病 慢性 酸碱失衡 三重型 

分 类 号：R541.5[医药卫生—心血管疾病] R589.6[医药卫生—内科学]