[医学]Acid-Base Balance and Disturbances7.pptVIP

Acid - Base Balance and Imbalance Pathophysiology Department. Hu Zhi-ping Regulation of acid - base balance酸碱平衡的调节 1. Buffer systems 缓冲系统 2. Bicarbonate buffer system  H2CO3 / HCO3-缓冲系统 Parameters of acid – base balance 反映血液酸碱平衡的常用指标 buffering 缓冲 ---- immediately HA + NaHCO3 ? NaA + H2CO3 2) Respiratory compensation 呼吸系统的代偿 ?Ventilation in few min, maximal in 12-24 h Cell effection 细胞的作用--- in 2-4h H+-K+ exchange → K+↑ (hyperkalemica) Renal compensation 肾脏的代偿 ------ 排酸保碱作用↑ begin in several h, maximal in 3-5d 1. Buffering ---- immediately 1）buffering 缓冲 ---- immediately HA + NaHCO3 ? NaA + H2CO3 2) Respiratory compensation 呼吸系统的代偿 ↓Ventilation in few min, maximal in 12-24 h 3）Cell effection 细胞的作用--- in 2-4h H+-K+ exchange → K+ ↓(hypokalemica) 4）Renal compensation 肾脏的代偿 ------ 排酸保碱作用↓ begin in several h, maximal in 3-5d Mixed acid-base disorders Metabolic Metabolic acidosis alkalosis Respiratory Respiratory acidosis alkalosis Metabolic Metabolic acidosis alkalosis Respiratory Respiratory acidosis alkalosis Analysis of simple acid-base disorder 机制 当HCO3-浓度降低，而同时伴有Cl-浓度代偿性升高。 原因： (1)HCO3-丢失 腹泻、肠道引流等； 肾小管性酸中毒（RTA） 碳酸酐酶抑制剂应用； (2) 固定酸排出减少 轻、中度肾衰； (3)摄酸过多 含氯的酸性药 2. Normal AG Metabolic Acidosis AG正常型代酸 Compensation of metabolic acidosis 机体的代偿调节 调节的最终目标:使[HCO3-]/[H2CO3]＝20/1左右。通过调节，pH仍在正常范围，则为代偿性代酸,否则为失代偿性代酸。 Compensation of metabolic acidosis 机体的代偿调节 PH ＜ 7.35 SB↓、AB↓、 AB＜SB BB↓ BE ↓(negative value of BE increases)； PaCO2 ↓ AG may or may not increase K+ ↑ Cl- ↑ (normal AG) or be normal( high AG) Changes of Acid-Base Parameters and Electrolytes Alterations of Metabolism and Function