Click here to load reader

第三章 酸碱平衡和酸碱平衡紊乱

  • View
    139

  • Download
    0

Embed Size (px)

DESCRIPTION

第三章 酸碱平衡和酸碱平衡紊乱. Acid-Base Disturbance. 体液 酸碱度 相对恒定 是维持内环境稳定的重要组成部分之一。. 机体自动维持体内酸碱相对稳定的过程,称为 酸碱平衡( acid-base balance ) 。. 因机体出现酸碱超负荷、严重不足或调节机制障碍,导致体内酸碱稳态破坏,称为 酸碱平衡紊乱( acid-base disturbance )或酸碱失衡( acid-base inbalance ) 。. H 2 CO 3 H + +HCO 3 - NH 4 + H + +NH 3 - PowerPoint PPT Presentation

Text of 第三章 酸碱平衡和酸碱平衡紊乱

  • acid-base balance acid-base disturbanceacid-base inbalanceAcid-Base Disturbance

  • H+H+Acid-Base Disturbance

  • 1. volatile acid CO2 CO2H2CO3 Acid-Base Disturbance

  • 2.fixed acid H3PO4H2SO4- 3. ()Acid-Base Disturbance

  • NH3Acid-Base Disturbance

  • Acid-Base Disturbance

  • 3-1 Acid-Base Disturbance

  • 3-2 Acid-Base Disturbance

    %HCO3- 35HCO3- 18Hb-HbO2-35Pr -7HPO4 -5

  • NaHCO3/H2CO3

    Acid-Base Disturbance

  • pH 7.357.45

  • 7.357.45 HCO3 7.45 H2CO3

  • [HCO3-]PaCO2pH

    pH7.4 ~ 7.45 pH7.4 ~ 7.35

    pH 7.45; 7.35

  • 2.

  • :PCO2 3346mmHg[H2CO3]PCO2[HCO3-] ,,CO2 PCO2[HCO3-] ,,CO2 PCO2

  • H2CO330 Acid-Base Disturbance

  • HCO3- CA) 35 35 [HCO3-] 22--27mmol/L

  • H+ NH4+HCO3-;H+;

    H+

  • [HCO3-] H+ NH4+HCO3- [HCO3-] H+ NH4+HCO3-

  • [H2CO3] [HCO3-] H+ NH4+HCO3-[H2CO3] [HCO3-] H+ NH4+HCO3-

  • 24 h

    Acid-Base Disturbance

  • ABSBBE PaCO2

  • pH [H+]pH = 7.40.051pH 7.45; 7.352pH [HCO3-]PaCO2 [HCO3-]PaCO2 a. pH7.4pH7.4~7.45pH7.4 ~7.35 b. Acid-Base Disturbance

  • PaCO2 PaCO2 CO2 33 ~ 46 mmHg (40 5 mmHg )1. 33 mmHg () ()Acid-Base Disturbance2. 46 mmHgCO2 () ()

  • [HCO3-] 1SB 38 100%PCO240 mmHg.

    1 HCO3- 22 27 mmol/L 243 mmol/L

    Acid-Base Disturbance

  • 2. AB

    1HCO3- 22 27 mmol/L243 mmol/L Acid-Base Disturbance

  • 1()() ()()2ABSB[HCO3-]SBABPaCO2Acid-Base Disturbance

  • PaCO240 mmHgABSBCO2PaCO2> 40 mmHgAB >SB PaCO2 ) ABSBBE ABSBBEAcid-Base Disturbance

  • PaCO2< 40 mmHg AB< SB PaCO2 ) ABSBBE ABSBBEAcid-Base Disturbance

  • 3BE 1pH7.4 + - 03 mmol/L (-3 ~ +3 mmol/L)Acid-Base Disturbance

  • [HCO3-]PaCO2 [HCO3-] Acid-Base Disturbance

  • 11.AG 2 GFR 3Acid-Base Disturbance

  • 2.AG 13H+HCO3-H+HCO3-CA2HCO3-4NH4ClHClAcid-Base Disturbance

  • anion gap, AG UAUC AG=UA-UC=[Na+]-[Cl-]-[HCO3-] =122 mmol/L AGSO42-HPO42- AG>16 mmol/L AG [Na+]+UC = [Cl-]+[HCO3-]+UAAcid-Base Disturbance

  • AG 1AG2AG AGAGAcid-Base Disturbance

  • 1. [H+] HCO3-ABSBBE; 2.PaCO2 CO2 Acid-Base Disturbance

  • Acid-Base Disturbance

  • 3. [HCO3-] H+ NH4+HCO3- 4.[H+] H+(24h) [H+]iICF [K+]e5. ABSBBEPaCO2 ABSBpH 7.357.4 7.35

  • 1. a. CA b. Ca2+Ca2+ , Ca2+ H+Ca2+ c. Acid-Base Disturbance

  • 2. CNS a.CNS b. -1.2.:NaHCO33.3.Acid-Base Disturbance

  • : Acid-Base Disturbance

  • PaCO2H2CO3 CO2CO2 1 CO22CO2 Acid-Base Disturbance

  • 1.Acid-Base Disturbance

  • 2.24 h H+NH4+HCO3-[HCO3-]e PaCO2ABSBBE ABSBpH7.4 ~ 7.357.35 1.CO2Acid-Base Disturbance

  • 2. CNS CNSCO2 CO2 CNS CNS() CO2CO2Acid-Base Disturbance

  • 1. 2. 3. :NaHCO3 THAM

    Acid-Base Disturbance

  • [HCO3-] 1. H+Cl-1 [HCO3-]2H+ Cl- Cl-Na+H2O H+-Na+H+ Cl- HCO3- [HCO3-]Cl- H+K+ Acid-Base Disturbance

  • 2.NaHCO3NaHCO3 3.K+ H+ [H+]i[H+]e() 4. NH3H+Acid-Base Disturbance

  • 1. HCO3- ABSB H+K+ [H+]iICF[K+]eAcid-Base Disturbance

  • 3. H+NH4+HCO3- Cl-[Cl-]Cl- - HCO3- K+K+H+HCO3- Acid-Base Disturbance

  • 1.CNS pH- CNS- pHHbO2 HbO2 O2 3.Acid-Base Disturbance

  • PaCO2H2CO3 CO2 CO2PaCO2 Acid-Base Disturbance

  • 1. ECFAB H+K+ ICF CO2HCO3- Acid-Base Disturbance 2. PaCO2[H+]

  • 3. H+NH4+HCO3- HCO3-[HCO3-] Acid-Base Disturbance

  • () 1. CNS PaCO2 PaCO2 CNS 2.PaCO2[H+]e Ca2+ ; ; CO2 Acid-Base Disturbance

  • 1.CO2 1CO2 22. [HCO3-]/ PaCO2pHAcid-Base Disturbance

  • 1. CO2 2. [HCO3-] / PaCO2pH Acid-Base Disturbance

  • 1. CO2 NaHCO3 2. pH Acid-Base Disturbance

  • 1. 2. pHAcid-Base Disturbance

  • 1. 2.pH[HCO3-]PaCO2AGAcid-Base Disturbance

  • ,,Acid-Base Disturbance

  • Acid-Base Disturbance

  • , pH 7.42, PaCO2 70 mmHg, AB 45 mmol/LSB 38 mmol/L BE 15 mmol/LPaCO2= 0.7[HCO3-]5 = 0.7(45-24)5=19.7 9.7PaCO2= 40+ 19.7 40 + 9.7=59.749PaCO2> +pHCO2 (? )H+[HCO3-]Acid-Base Disturbance

  • pHPaCO2[HCO3-],

    pH 7.42PaCO2 70 mmHg AB 45 mmol/LSB 38 mmol/L BE 15 mmol/LAcid-Base Disturbance

  • 1.AG2. AG AG Acid-Base Disturbance

  • 3. Acid-Base Disturbance

Search related