危重病三重酸碱失衡发生率与影响因素  

Incidence and influencing factors of triple acid - base disorder in critical ill patients

作　　者：顾文华[1] 宋志芳[2] 李浩军[2] 陈光榆[3] 

机构地区：[1]温州医学院研究生部,浙江325035 [2]上海交通大学医学院附属新华医院急救中心,200092 [3]上海交通大学医学院临床流行病学研究中心,200092

出　　处：《中国急救医学》2010年第1期19-23,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的了解危重病三重酸碱失衡（TABD）发生率与影响因素。方法收集上海交通大学医学院附属新华医院急诊抢救室2008—12—01～2009—03—31所有危重病患者的临床资料[性别、年龄、急性生理及慢性健康状况评分Ⅱ（APACHEⅡ）、多器官功能障碍综合征（MODS）发生率、病死率等]，同步检测动脉血气分析和血电解质，计算阴离子隙（AG）、潜在HCO3^- 依据TABD诊断标准，了解TABD的发生率，并与非TABD患者进行比较与分析。结果766例患者中，TABD患者71例（9．3％），年龄[（77．9±10．7）岁]大于非TABD组[（69．8±17．8）岁，P〈0．01]，APACHEⅡ评分[（25．86±7．07）分]高于非TABD组[（20．96±7．99）分，P〈0．01]，MODS发生率（16例，22．5％）高于单纯ABD组（6例，3．8％，P〈0．01）和二重ABD组（15例，2．9％，P〈0．01），1d内、1～2d、2—3d和3～7d病死率（14．1％、23．9％、26．8％、38．0％）高于单纯ABD组（4．5％、9．1％、11．0％、14．3％，P〈0．05或P〈0．01）和二重ABD组（4．5％、7．5％、8．3％、10．7％，均P〈0．01）。结论危重病TABD发生与年龄、APACHEⅡ评分、原发病有关，预后差。Objective To investigate the incidence and influencing factors of triple acid - base disorder （TABD） in critical ill patients. Methods The clinical data including age, gender, APACHE H scores, multiple organ dysfunction syndrome （ MODS）, mortality and so on for all the patients in emergency first - aid room of Xinhua Hospital Affiliated to Shanghai Jiaotong University were collected from December 1, 2008 to March 31, 2009. Their arterial and venous blood samples were taken simultaneously in order to test arterial blood gas analysis and blood electrolytes, and anion gap （AG） and potential HCO3^- were calculated. TABD was diagnosed according to the criteria of TABD, the incidence of TABD was investigated in these patients. The patients with TABD was compared with the non -TABD patients. Results There were totally 766 cases and the incidence of TABD was 9.3% （71 cases）. Comparing with non - TABD patients, TABD group were elder （P 〈 0.01 ）, their APACHE Ⅱ score were higher （P 〈 0.01 ）, the incidence of MODS were higher （P 〈0. 01 ）and mortality were higher （P 〈 0.05）. Conclusion In critical ill patients, the incidence of TABD is correlated with age, APACHE H score, the primary diseases and other various susceptible factors. The prognosis of them was poor.

关 键 词：三重酸碱失衡(TABD) 阴离子隙(AG) 潜在HCO3^- 

分 类 号：R181.34[医药卫生—流行病学] R541.5[医药卫生—公共卫生与预防医学]