酸碱平衡紊乱及分析-研究与研讨生.ppt

Acid-base Balance and Imbalance;Acid-base balance;  因酸碱负荷过度、不足或调节机制障碍导致体液酸碱度稳定性失衡的病理过程。 ;Normal acid-base balance ;1. Acid---- H+ donor;daily production ：300-400L/d ;volatile acid;Base-- H+ acceptor;Regulation of acid-base balance;1. Buffer systems in body fluid;HPr;PaO2 pH;特点： 作用较快 (数分钟内开始发挥作用，30分钟达到高峰)； 代偿能力大； 只对挥发性酸有效。;3. Renal regulation; NaHCO3重吸收 (bicarbonate conservation) ;肾小管上皮细胞;;;4.Cellular regulation;组织细胞;; Parameters of acid-base balance;1. pH; pH正常; 2. PaCO2 --“respiratory factor”. (Partial pressure of carbon dioxide) ;PaCO246mmHg Primary increase: respiratory acidosis Secondary increase: metabolic alkalosis (compensated by lung) PaCO233mmHg Primary decrease: respiratory alkalosis Secondary decrease: metabolic acidosis (compensated by lung) ;3. AB (actual bicarbonate); 4. SB (Standard bicarbonate) ;AB 和 SB关系：;5. BB (buffer base) ; 6.BE (base excess);Normal BE= -3.0~+3.0 Only metabolic factor determines BE In metabolic alkalosis the positive BE increases. In metabolic acidosis the negative BE increases.;7. AG (anion gap) (阴离子间隙) ;;AG = UA - UC;常用指标小结★★★ ;Simple acid-base disturbance ;*;; 1. Metabolic acidosis;案例4-1：;主要原因： HCO3- 丢失↑； 　　固定酸过多;(2) Disorders in the excretion of acidic metabolites Renal failure: ;2) Kidney loss of HCO-3 : Type II renal tubular acidosis（RTA-II）: Ⅱ型-近端肾小管性酸中毒（Proximal RTA). 是近端小管重吸收HCO3-障碍引起的。 Depressant of C.A;(5） Blood dilution  大量输入生理盐水，引起HCO3- 稀释 (6） Hyperkalemia;血浆;（2）Classification; AG增大型代酸;1）缺氧、严重肝病—→乳酸生成↑，转化处理障碍—→乳酸↑； 糖尿病、饥饿等—→脂肪动员↑—→酮体生成↑。; AG正常型代酸;1）腹泻：大量碱性肠液丢失;;Respiratory regulation:;加强泌H ＋ 、泌NH4＋，回吸收HCO3-;Compensation by cells and bone;慢性骨损伤-----Chronic metabolic acidosis ;(4) Changes of parameters and electrolytes ;案例4-1：;(5）Alterations of metabolism and function;*; shock？;CNS-------“抑制” ; Respiratory system;案例4-1：;治疗原发病(treatment of primary disease); 2