acid-base disturbance(酸碱平衡紊乱)教程文件.pptVIP

Significance PaCO246mmHg Primary increase: respiratory acidosis Secondary increase: metabolic alkalosis (compensated by lung) PaCO233mmHg Primary decrease: respiratory alkalosis Secodary decrease: metabolic acidosis (compensated by lung) 3) Actual bicarbonate (AB) Standard bicarbonate (SB),  SB is measured under “standard condition” (temperature 37~38℃, full oxygenation of hemoglobin, PaCO2 = 40 mmHg). Standard condition means that the respiratory factor is eliminated, then the [HCO3ˉ ] is only affected by metabolic factor. The normal [HCO3ˉ ] is 22~27(24) mmol/L. Higher SB means metabolic alkalosis or respiratory acidosis compensated by kidneys. Low SB means metabolic acidosis or respiratory alkalosis compensated by kidneys. AB is measured under “actual condition”. because the blood sample is sealed off from air after its taking, the PaCO2 is maintained at its original level. So, AB is influenced by both respiratory factor and metabolic factor. Normally the AB=SB. If ABSB (CO2 retention), the reason must be the effect of respiratory factor, which indicates respiratory acidosis or metabolic alkalosis compensated by lung. If ABSB (CO2 depletion), the reason must be the respiratory factor, which means respiratory alkalosis or the metabolic acidosis compensated by lung. 4) Buffer base (BB) Sum of all buffer bases in blood In plasma: HCO3 ˉ =24 Proteinˉ =17 In RBC: Hbˉ HbO2ˉ =6.3 HPO4 2ˉ =1.0 BB=45~52 mmol/L(48) Determined by metabolic factors 5) Base excess (BE) Under “standard condition” (temperature 37~38℃, full oxygenation of hemoglobin, PaCO2 = 40 mmHg), titrate the whole blood to pH7.4 with how much acid or base (mmol/L). If with acid, there is must more base (excess) in the blood, BE is expressed with positive value If with base, there is must more acid (de