第四章 酸碱平衡紊乱详解.pptVIP

Acid-base disturbance is a common basic pathological process in which, because of the actions of certain causative factors, the quantitative abnormal changes of acidic or alkaline substance within the body (overload or obvious shortage) are beyond the regulative abilities of the body, or the regulative mechanisms themselves are disrupted, or the coexistence of these two situations occurs, the normal acid-base homeostasis is damaged. 正常值：4.39~6.25kPa(33~46mmHg) 平均5.32 kPa (40mmHg) 意义：为反映呼吸性酸碱平衡紊乱的重要指标 PaCO26.25kPa 为肺泡通气不足 PaCO24.39kPa 为肺泡通气过度 Anion gap (AG) It is the deference between the concentrations of unmeasured anion (UA) and unmeasured cation (UC) in plasma (AG=UA-UC). The AG value can be obtained by calculating the difference between plasma concentration of major measured cation (Na+) and the sum of the plasma concentrations of major measured anions (Cl- and HCO3-), that is, AG = [Na+] - ([Cl-] + [HCO3-]). Its normal range is 12±2 mmol/L. （一）原因及发病机制 1. AG增大型代谢性酸中毒 基本机制是由于血浆固定酸增加过多，HCO3-因中和H+而减少，而与固定酸（HA）对应的碱（A-）在体液中蓄积而致AG增大，但血氯浓度正常。 When oxygens deficiency occurs due to various causes, glucose can be converted into lactic acid by the way of anaerobic glycolysis. If the increase of lactic acid exceeds the utilization ability of the liver, or if the lactic acid cannot be utilized sufficiently by the severely damaged liver, the concentration of lactic acid in blood will rise remarkably and a metabolic acidosis follows. At this time, the sodium bicarbonate in blood is consumed in the process of neutralizing increased hydrogen ions dissociated from lactic acid. Meanwhile, the latters remainder, the radical of lactic acid, joins the AG. Therefore lactic acidosis is a kind of metabolic acidosis with a high AG. Keto-acidosis 酮体产生过多：糖尿病：葡萄糖利用障碍饥饿、禁食：葡萄糖供给不足致使脂肪分解加速：乙酰乙酸、 β-羟丁酸↑。 Under the conditions of diabetes, hunger or alcohol intoxication, etc., because of the shortage or metabolic obstruction of glucose, th