危重病患者的三重酸碱失衡分析  

Analysis of triple acid-base disturbances in critical ill patients

作　　者：任成山[1] 陆海华[1] 赵志强[2] 郭中杰[1] 高全杰[1] 钱桂生[2] 

机构地区：[1]中国人民解放军第三军医大学附属新桥医院急诊科,重庆400037 [2]中国人民解放军全军呼吸内科研究所

出　　处：《中国急救医学》2003年第5期289-291,共3页Chinese Journal of Critical Care Medicine

基　　金：全军"十五"重点课题资助项目 (No 0 1z0 74)

摘　　要：目的　提高对危重病患者三重酸碱失衡 (TABD)的诊断和救治水平。方法　分析了 168例危重病患者的TABD动脉血气、血清电解质参数及临床资料。结果　 168例中呼吸性碱中毒合并代谢性碱中毒并代谢性酸中毒 (呼碱型TABD) 12 1例 (72 0 % ) ;呼吸性酸中毒合并代谢性碱中毒并代谢性酸中毒 (呼酸型TABD) 4 7例 (2 8 0 % )。 168例中pH >7 45者92例 (5 4 8% ) ,pH <7 3 5者 3 9例 (2 3 2 % ) ;PaO2 <80mmHg者 75例 (4 4 6% ) ,其中PaO2 <60mmHg者 41例 (5 4 6% ) ;潜在〔HCO3-〕升高者 113例 (67 2 % ) ;AG >18mmol/L者 168例。全组中死亡者 69例 (4 1 1% )。结论　呼吸性碱中毒伴AG值升高 ,且符合潜在〔HCO3-〕 =实测〔HCO3-〕 +△AG >2 4+ 0 5×△PaCO2 + 2 5 ,可判断为呼碱型TABD ;呼吸性酸中毒伴AG值升高 ,且符合潜在〔HCO3-〕 =实测〔HCO3-〕 +△AG >2 4+ 0 3 5×△PaCO2 + 5 5 8。Objective To improve the diagnosis and treatment of triple acid-base disturbance (TABD) in critical ill patients. Methods Clinical features , arterial blood gas and plasma electrolytes of 168 critical ill patients were analyzed. Results Of the total 168 patients , 121(72.0%) had TABD of respiratory alkalosis, 47(28.0%) had TABD of respiratory acidosis . pH>7.45 was found in 92 patients (54.8%), and pH<7.35 in 39 patients (23.2%). PaO 2<80 mmHg was found in 75 patients (44.6%) ,and PaO 2<60 mmHg in 41 patients (54.6%). The potential 〔HCO 3 -〕 increased in 113 patients (67.2%) and anion gap(AG)>18 mmol was found in 168 patients. The mortality was 41.1% (69 patients). Conclusion TABD of respiratory alkalosis could be diagnosed when there appeared respiratory alkalosis, increased AG and potential〔HCO 3 -〕>24+0.5×△PaCO 2+2.5. TABD of respiratory acidosis could be diagnosed when there were respiratory acidosis, increased AG and potential 〔HCO 3 -〕>24+0.35×△PaCO 2+5.58.

关 键 词：危重病患者 三重酸碱失衡 分析 诊断 阴离子隙 动脉血气分拆 

分 类 号：R446.11[医药卫生—诊断学]