动脉血气分析讲解 .pptx

动脉血气分析;内容提要;O2的转运;CO2转运;外呼吸——肺内O2 的运载和CO2 释放;内呼吸——组织中CO2 的运载和O2 的释放;DEFINITION;常用指标及正常值;PaO2 SaO2 O-H 解离曲线;（1）PaO2;Atmospheric Pressure;（2）SaO2;（3）Oxygen-Hemoglobin Dissociation Curve;（4）Oxygen content ;（5）D(A-a)O2;（6）Index of Oxygenation (IO);2. PaCO2;3. pH：[H+]负对数;4. HCO3-;5. Base Excess (BE);6. Anion Gap (AG);7. 潜在HCO3- (potential or corrected); 酸碱失衡的类型;单纯性酸碱紊乱的常见原因;酸碱平衡的调节;1. 全血缓冲系统;2. 肺脏代偿;3. 肾脏代偿;4. Intra- & Extracellular Ion Exchange ; 酸碱紊乱的诊断方法;Step 1: 确定有无酸碱平衡紊乱？ Acidemic (pH<7.35) or Alkalemic (pH>7.45)? Step2: 原发性紊乱（呼吸/代谢）? 病史+ 动脉PaCO2 或 HCO3- pH ?：PaCO2?，呼吸性 / HCO3- ?，代谢性 pH ?：PaCO2?，呼吸性 / HCO3- ?，代谢性;酸碱平衡紊乱的诊断程序（1）;Step 4: 若为代酸, 确定有无AG?? AG越大，判定代酸越可靠，但AG正常，不等于无代酸（高氯性酸中毒）;Step 5: 若AG ? ，计算潜在碱，确定有无其他代谢性因素存在？(三重酸碱紊乱） corrected HCO3- = measured HCO3- + (AG-12) corrected HCO3- = normal HCO3-，单纯代酸 corrected HCO3- < normal HCO3-，复合代酸 corrected HCO3- > normal HCO3-，合并代碱;Step 6: 确定代谢性紊乱后，判定呼吸代偿或失代偿? Expected PaCO2 = [1.5 ? 血HCO3-] + 8 ? 2 实测 PaCO2> 预计PaCO2, 提示原发性呼酸;2. 4-5-6-7 Method for Identifying Acid-base Disturbances and Their Compensation Limit;3. 掌握酸碱变化规律;Sample Problem-----Case 1;Sample Problem-----Case 2;酸碱紊乱的治疗;追 求 最 高 境 界;1、Genius only means hard-working all one's life. (Mendeleyer, Russian Chemist)? 天才只意味着终身不懈的努力。20.8.58.5.202011:0311:03:10Aug-2011:03 2、Our destiny offers not only the cup of despair, but the chalice of opportunity. (Richard Nixon, American President )命运给予我们的不是失望之酒，而是机会之杯。二〇二〇年八月五日2020年8月5日星期三 3、Patience is bitter, but its fruit is sweet. (Jean Jacques Rousseau , French thinker)忍耐是痛苦的，但它的果实是甜蜜的。11:038.5.202011:038.5.202011:0311:03:108.5.202011:038.5.2020 4、All that you do, do with your might; things done by halves are never done right. ----R.H. Stoddard, American poet做一切事都应尽力而为，半途而废永远不行8.5.20208.5.202011:0311:0311:03:1011:03:10 5、You have to believe in yourself. That's the secret of success. ----Charles Chaplin人必须相信自己，这是成功的秘诀。-Wednesday, August 5, 2020August 20Wednesday, August 5, 20208/5/2020 6、Almost any situation---good or