1.动脉血气分析六步法（1. arterial blood gas analysis six steps）.docVIP

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1.动脉血气分析六步法（1. arterial blood gas analysis six steps）.doc

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1.动脉血气分析六步法（1. arterial blood gas analysis six steps）

1.动脉血气分析六步法（1. arterial blood gas analysis six steps） Six step method of arterial blood gas analysis [step 1] evaluate the intrinsic consistency of blood gas values based on the Henderseon-Hasselbach formula: [H+]=24x (PaCO2) /[HCO3-]. If the pH and [H+] values are not consistent, the blood gas results may be wrong PH estimation of [H+] (mmol/L) 7.00100 7.0589 7.1079 7.1571 7.2063 7.2556 7.3050 7.3545 7.4040 7.4535 7.5032 7.5528 7.6025 7.6522 [Second] the existence of alkalemia or step acidemias? PH 7.35 Acidemia PH 7.45 alkalemia Usually this is the primary abnormality; Remember: even if the value of pH in the normal range (7.357.45), there may be acidosis or alkalosis; You need to check the PaCO2, HCO3-, and anion gaps. [third step] is there any respiratory or metabolic disorder? What is the relationship between the direction of pH value change and the direction of PaCO2 change? In primary respiratory disturbances, pH and PaCO2 change in the opposite direction; in primary metabolic disturbances, pH and PaCO2 change in the same direction: Respiratory acidosis: case PaCO2 = pH Metabolic acidosis: pH:: PaCO2 Respiratory alkalosis: pH = PaCO2: Metabolic alkalosis: pH = PaCO2 = [step fourth] is there an appropriate compensation for primary abnormalities? Normally, the compensatory response does not restore pH to normal (7.35-7.45) Abnormal expected compensatory response correction factor Metabolic acidosis, PaCO2= (1.5x[HCO3-]), +8 + 2 Acute respiratory acidosis, elevated [HCO3-] = PaCO2/10 + 3 In chronic respiratory acidosis (3-5 days), [HCO3-] increased by =3.5x (PaCO2/10) Metabolic alkalosis increased PaCO2 by =0.6x (HCO3-) In acute respiratory alkalosis, [HCO3-] decreased by =2x (PaCO2/10) Chronic respiratory alkalosis, [HCO3-], decreased =5x (PaCO2/10) to 7x (PaCO2/10) If the observed degree of compensation does not correspond with the expected compensatory response, there may be more than one acid-base abnormality. [fifth step] calculate the anion gap (if there