病理生理学课件_C第四章酸碱平衡紊乱.pptVIP

酸碱平衡和 酸碱平衡紊乱 Acids and Bases Buffers Buffers resist changes in pH convert strong acids or bases to weak ones Physiological buffer systems control output of acids, bases or CO2 urinary system respiratory system Chemical buffer systems restore normal pH in fractions of a second bicarbonate, phosphate and protein systems Bicarbonate Buffer System Solution of carbonic acid and bicarbonate ions CO2 + H2O ? H2CO3 ? HCO3- + H+ Reversible reaction important in ECF CO2 + H2O ? H2CO3 ? HCO3- + H+ lowers pH by releasing H+ CO2 + H2O ? H2CO3 ? HCO3- + H+ raises pH by binding H+ Functions with respiratory and urinary systems to lower pH, kidneys excrete HCO3- to raise pH, kidneys and lungs excrete CO2 排出代谢过程中产生的H+ 重吸收肾小球滤过的HCO3- 动脉血二氧化碳分压 全血在标准条件下（T 370C、Hb 100%饱和PaCO240 mmHg）所测的HCO3- 阴离子间隙（AG） AG=未测定阴离子-未测定阳离子 =Na+ -(HCO3-+Cl-） =12mmol/L 代谢性酸中毒 metabolic acidosis 定义： 原发性HCO3-减少,严重可导致的 pH 代谢性酸中毒 AG正常型代谢性酸中毒 下消化道丢失HCO3- 肾小管酸中毒（HCO3-丢失） 碳酸酐酶抑制剂的使用 含氯成酸性药物摄入过多 机体的代偿 血液缓冲和细胞内缓冲 肺的代偿调节作用 肾的代偿调节 组织细胞的调节 代谢性碱中毒Metabolic alkalosis 定义：血浆中HCO3-原发性增高而致pH增高 呼吸性碱中毒 respiratory alkalosis 定义：PaCO2原发性减少而致pH 慢性呼吸性碱中毒：见于慢性颅脑疾病 肺部疾患 分类及机体的代偿 急性呼吸性碱中毒：PaCO2在24小时内急剧下降 常见于人工通气过度、 高热、低氧血症等 慢性呼吸性碱中毒：见于慢性颅脑疾病 肺部疾患 混合型酸碱平衡紊乱 A 14-year-old girl with cystic fibrosis has complained of an increased cough productive of green sputum over the last week. She also complained of being increasingly short of breath, and she is noticeably wheezing(喘息) on physical examination. Arterial blood was drawn and sampled, revealing the following values: 1. . Cystic fibrosis (CF), the most common inherited disease among Caucasians, is an autosomal recessive disorder that is marked by the production of excessively thick mucus in the respiratory tract, pancreatic ducts, and biliary tree. Individuals with CF produce a