复杂动脉血气分析解读-精选文档.ppt

依慢性呼酸预计代偿公式： △HCO3- =0.35×△PaCO2±5.58 =0.35×31.7±5.58 =11.095±5.58 预计HCO3-=24＋△HCO3- =24＋(11.095±5.58 ) =35.095. ±5.58 AG=Na+－(HCO3-＋Cl-) =138－(32.8＋78) =27.2 △ AG=实测AG－12 =27.2－12=15.2 “潜在”HCO3-=实测HCO3-＋△AG =32.8＋15.2 =48＞40.675 说明有呼酸型三重酸碱失衡。 女，49岁，肝昏迷，右侧胸腔中等量积液，上消化道出血，肝肾综合症患者。PH：7.463，PaCO2：30 ，HCO3-：20.4，PaO2：48，Na+：136，Cl-：94。 肝昏迷及中等量胸腔积液，可使患者过度呼吸，CO2排出过多，PaCO2降低，提示呼喊，依慢性呼碱预计代偿公式： 例：呼碱型三重酸碱失衡 △ HCO3-=0.5×△PaCO2±2.5 =0.5×(-10)±2.5=-5±2.5 =-7.5~-2.5 预计HCO3-=24＋△HCO3- =24＋（-7.5~-2.5)=16.5~21.5 AG=Na+－(HCO3-＋Cl-) =136－(20.4+94) =21.6 △AG=实测AG－12 =21.6－12=9.6 “潜在”HCO3-=实测HCO3-＋ △ AG =20.4＋9.6=30＞21.5 说明有呼碱型三重酸碱失衡。 4. 肾在呼吸性酸碱平衡失调中的调节过程： 呼酸时H2CO3↑,肾脏通过下列途径代偿，使NaHCO3↑,确保NaHCO3 / H2CO3比值仍在20/1, pH值在正常范围。 ①泌H+排酸 ②泌氨中和酸 ③HCO3— 再吸收 调节时间：约6～18h开始，36～48h完成，72h减弱，有的5～7d达最大代偿，老年人有时长达3～4w 。 血气分析判定方法 (三参预计看AG) Rules of Thumb for Recognizing Primary Acid-Base Disorders Without Using a Nomogram Rule 1 Look at the pH. Whichever side of 7.40 the pH is on, the process that caused it to shift to that side is the primary abnormality. Principle: The body does not fully compensate for primary acid-base disorders Rule 2 Calculate the anion gap. If the anion gap is ? 20 mmol/L, there is a primary metabolic acidosis regardless of pH or serum bicarbonate concentration Principle: The body does not generate a large anion gap to compensate for a primary disorder Rule 3 Calculate the excess anion gap (the total anion gap minus the normal anion gap [12 mmol/L]) and add this value to the measured bicarbonate