氧供需平衡-麻醉课件演示文稿.pptVIP

病理性氧供依赖(Pathalogical Supply Dependence) 危重病人的DO2处于正常或高于正常时，便可出现氧供依赖性氧耗，即DO2上升或下降时，氧摄取量均保持不变，VO2和DO2呈线性关系，这种在病理状态下形成的氧供依赖称为病理性氧供依赖。与生理性氧供依赖的区别在于其氧供临界阈值较高，见图3。浅低温可能会导致组织摄氧障碍，其原因可能是氧供降低和氧释放困难。吸入麻醉药氟烷可增加不同氧供状态下的摄氧率，有利于机体在低氧供状态下机体对氧的利用。 * The oxygen-hemoglobin dissociation curve. Four different ordinates are shown as a function of oxygen partial pressure (the abscissa). In order from right to left, they are: saturation (%), O2 content (mL of O2/0.1 L) of blood; O2 supply to the peripheral tissues (mL/min); and O2 available to the peripheral tissues (mL/min), which is O2 supply minus approximately 200 mL/min that cannot be extracted below a partial pressure of 20 mm Hg. Three points are shown on the curve: a, normal arterial; v, normal mixed venous; and P50, the partial pressure (27 mm Hg) at which hemoglobin is 50 percent saturated. The oxy-Hb dissociation curve relates the saturation of Hb to the PaO2. Hb is fully saturated (100%) by a PO2 of about 700 mm Hg. The normal arterial point on the right side and flat part of the oxy-Hb curve is 95 to 98 percent saturation by a PaO2 of about 90 to 100 mm Hg. When the PO2 is less than 60 mm Hg (90% saturation), the saturation falls steeply, so that the amount of Hb uncombined with O2 increases greatly for a given decrease in PO2. Mixed venous blood has a PO2 (P O2) of about 40 mm Hg and is approximately 75 percent saturated; this is indicated by the middle of the three points on the oxy-Hb curve in Figure 15–25. * * The causes of a left-shifted oxy-Hb curve are alkalosis (metabolic and respiratory— the Bohr effect), hypothermia, abnormal and fetal Hb, carboxyhemoglobin, methemoglobin, and decreased RBC 2,3-diphosphoglycerate (2,3-DPG) content (which may occur with transfusion of old acid-citrate-dextrose [ACD]– stored blood; storage of blood in citrate-phosphate-dextrose [CPD] minimizes changes in 2,3-DPG with time). * A P50 higher than 27 mm Hg describes a right-shifted oxy-Hb curve, which means that at any given PO2, Hb