血气分析-英文版.pptxVIP

A Practical Approach to Acid-Base DisordersBin DU, MDMedical Intensive Care UnitPeking Union Medical College Hospital第一页，共四十五页。 Primary Acid-Base DisordersVariablePrimary DisorderNormal Range, Arterial GasPrimary DisorderpHAcidemia7.35 – 7.45AlkalemiaPCO2, mmHgRespiratory alkalosis35 – 45Respiratory acidosisHCO3, mmol/LMetabolic acidosis22 – 26Metabolic alkalosis第二页，共四十五页。 Rules of Thumb for Recognizing Primary Acid-Base Disorders Without Using a NomogramRule 1Look 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第三页，共四十五页。 Simple Acid-Base Disorders第四页，共四十五页。 Acute Respiratory AlkalosisArterial Gas ValueInterpretationpHPCO2*HCO37.5029 mmHg22 mmol/LAlkalemiaRespiratory alkalosisNormal HCO3CausesAnxietyHypoxiaLung disease with or without hypoxiaCentral nervous system diseaseDrug use – salicylates, catecholamins, progesteronePregnancySepsisHepatic encephalopathyMechanical ventilation*This is the primary abnormality第五页，共四十五页。 Acute Respiratory AcidosisArterial Gas ValueInterpretationpHPCO2*HCO37.2560 mmHg26 mmol/LAcidemiaRespiratory acidosisNormal HCO3CausesCentral nervous system (CNS) depression – drugs, CNS eventNeuromuscular disorders – myopathies, neuropathiesAcute airway obstruction – upper airway, laryngospasm, bronchospasmSevere pneumonia or pulmonary edemaImpaired lung motion – hemothorax, pneumothoraxThoracic cage injury – flail chestVentilator dysfunction*This is the primary abnormality第六页，共四十五页。 Chronic Respiratory Acidosis With Metabolic CompensationArterial Gas ValueInterpretationpHPCO2*HCO37.3460 mmHg31 mmol/LRespiratory acidosisMetabolic compensationCausesChronic lung disease – obstructive or restrictiveChronic neuromuscular disordersChronic respiratory center depression – central hypoventilation*This is the primary abnormality第七页，共四十五页。 The Importance of Differentiating Acute From Chronic Respiratory Aci