阴离子隙和潜在HCO-3诊断慢性呼吸衰竭酸碱失衡的临床意义.DOCVIP

临床医学论文-阴离子隙和潜在HCO-3诊断慢性呼吸衰竭酸碱失衡的临床意义 【关键词】? 阴离子 　?【摘要】? 目的? 探讨阴离子隙(AG)和潜在HCO-3判断酸碱失衡类型的应用。方法? 同步测定动脉血气和血电解质，以酸碱失衡预计代偿公式，结合AG值和潜在HCO-3对慢性呼吸衰竭患者进行酸碱失衡类型的判断。结果? （1）代谢性酸中毒（代酸）31例次，其中高AG代酸22例次，高Cl-代酸5例次，如不测定AG将有17例次代酸失检；（2）应用AG后，三重性酸碱失衡（TABD）从0增至14例次，在这14例次TABD中，如不应用潜在HCO-3将有8例失检。结论? （1）AG和潜在HCO-3在提高代酸和TABD诊断率方面发挥了重要的作用，并且提出判断TABD的标准和步骤；（2）因有诸多因素影响AG值，使某些代酸患者AG值不能相应地升高，临床应用时应予注意。 　　【关键词】? 酸碱平衡；呼吸衰竭 ???　　【Abstract】? Objective? To study the application of anion gap(AG)and potential HCO-3 judging the types of acid-base disturbance.Methods?The arterial blood gas and blood electrolytes must be determined synchronically.The expect compensatory formula of acid-base disturbance combined with the AG value and the potential HCO-3 evaluated the type of acid-base disturbance caused by chronic respiratory failure.Results? (1)In 31 cases of metabolic acidosis(MA),22 cases belong to that with elevated AG type,5 cases belong to that with hyperchloride type.If the AG value wasnt determined,17 cases of MA would not be found.(2)After determining AG value,the number of cases showing triple acid-base disturbance(TABD) increased from 0 to 14.In the 14 cases,8 cases would be lost, if potential HCO3-wasn抰 determined.Conclusion牋 (1) The AG value and potential HCO3- were of key significance in elevating the diagnostic rate of MA and TABD.Furthermore,the diagnostic criteria and steps of TABD were proposed.(2)Because there are many factors affecting the AG value,which fails to elevate correspondingly in some patients with MA,this condition should be attracted attention clinically. 　　【Key words】? acid-base disturbance;respiratory failure 　??? 慢性呼吸衰竭（简称呼衰）急性加重期，常并发各种类型酸碱失衡，且随着认识的逐步深化，多重性酸碱失衡类型在不断增多。为了准确判断慢性呼衰患者的酸碱失衡类型，笔者着重探讨了在采用酸碱失衡预计代偿公式的基础上，应用阴离子隙（anion gap,AG）和潜在HCO3-诊断慢性呼衰患者酸碱失衡类型，尤其是复杂型酸碱失衡的临床意义。并阐述了笔者的几点体会，避免临床误诊、漏诊。 　　1? 资料与方法 　　1.1? 一般资料? 81例肺心病慢性呼衰急性期患者，男49例，女32例。年龄42~78岁。全部病例均符合全国第三次肺心病会议制定的诊断标准。 　　1．2? 研究方法? 81例患者在治疗过程中，同步测定动脉血气（美国康170血气分析仪）和血电解质（美国Dimension RXL全自动生化仪）计154例次，将每次所测血气结果按酸