如何看血气分析结课件.ppt

Causes of Respiratory Alkalosis hyperventilation panic （恐慌 ） pain pregnancy acute anemia salicylate（水杨酸）overdose Metabolic Alkalosis plasma bicarbonate pH 7.45 HCO3 26 Causes of Metabolic Alkalosis loss acid from stomach or kidney hypokalemia excessive alkali intake Case Study No. 1 56 yo ? ? neurologic dz required ventilator support for several weeks. She seemed most comfortable when hyperventilated to PaCO2 28-30 mmHg. She required daily doses of lasix to assure adequate urine output and received 40 mmol/L IV K+ each day. On 10th day of ICU her ABG on 24% oxygen VS: ABG Results pH 7.62 BP 115/80 mmHg PCO2 30 mmHg Pulse 88/min PO2 85 mmHg RR 10/min HCO3 30 mmol/L VT 1000ml BE 10 mmol/L MV 10L K+ 2.5 mmol/L Case study No. 2 27 yo retarded（迟钝）? with insulin-dependent DM arrived at ER from the institution where he lived. On room air ABG VS: pH 7.15 BP 180/110 mmHg PCO2 22 mmHg Pulse 130/min PO2 92 mmHg RR 40/min HCO3 9 mmol/L VT 800ml BE -30 mmol/L MV 32L Step 4: Determine if there is a compensatory mechanism working to try to correct the pH. 四步法分析结果 酸碱平衡调节机制 体内酸碱的绝对量时时刻刻都在变动， pH 、[HCO3-]和H2CO3三者的关系 人体通过化学缓冲、离子交换、肺代偿、肾代偿四种基本形式，将PH值维持在一个狭窄的生理范围内。 [HCO3-] pH=6.1+log ------------ [H2CO3] 缓冲系 离子交换 2Na+ 1H+ 3K+ 3K+ 2Na+ 1H+ 血液中[H+]升高时 血液中[H+]降低时 肺代偿 约98%正常代谢产生CO2，是体内酸的主要来源，由肺脏排出。 CO2 + H2O H2CO3 机体通过调节CO2的排出量，从而维持酸碱平衡。 肾代偿 体内的固定酸及碱性物质必须经肾脏排出。主要有以下四种形式： NaHCO3的再吸收 肾小管内缓冲盐的酸化 氨的分泌与铵盐的生成 钾的排泄与K+--Na+交换 肾脏调节酸碱平衡的作用强大，但需要（3~5）天才能达到最大代偿能力 什么是代偿 In respiratory conditions, therefore, the kidneys will attempt to compensate and visa versa. In chronic respiratory acidosis (COPD) the kidneys increase the elimination of H+ and absorb more HCO3. The ABG will Show NL pH, CO2 and HCO3. Buffers kick in within minutes. Respiratory compensation is rapid and starts within minutes and complete within 24 hours. Kidney c