Ren Chengshan, Qian Guisheng, Guo Zhongjie, Gao Quanjie, Yang Songhua, Lu Haihua, Mao Baoling
Department of Emergency, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
Chin J Traumatol. 2000 May 15;3(2):107-110.
To investigate the classification and incidence of acid-base disturbance (ABD) in the patients with post-traumatic multiple organ dysfunction syndrome (MODS). METHODS: A total of 119 patients with MODS were examined with arterial blood gas analysis and serum electrolytes detection for 675 times in this study. RESULTS: Different types of ABD existed in 647 times out of 675 times (95.9%) of blood-gas analyses. There were 270 times (41.7%) of simple ABD, 271 times (41.9%) of double ABD and 106 times (16.4%) of triple ABD. Among which, 404 times (62.4%) were in respiratory alkalosis (RAL), 332 times (51.3%) in metabolic acidosis (MA), 227 times (35.1%) in metabolic alkalosis (MAL) and 167 times (25.8%) in respiratory acidosis (RA). In this study, 79 cases (66.4%) out of 119 cases with MODS died from these kinds of ABD. CONCLUSIONS: It suggests that in the early stage of MODS, RAL with or without hypoxemia may exist, and later on, MA or even triple ABD may occur. In order to detect and correct the primary disorders as early as possible, it is important to keep the balance of hydrolyte. The treatment of primary diseases is also important. Disorders of acid-base balance were corrected according to pH standard values, anion gap (AG) and the potential [HCO(3)(-)] were also calculated simultaneously. When pH was more than 7.50 or lower than 7.20, it is necessary to give drugs of acidity or alkalinity to the patients with ABD to maintain pH value within a normal range.
探讨创伤后多器官功能障碍综合征(MODS)患者酸碱平衡紊乱(ABD)的分类及发生率。方法:本研究对119例MODS患者进行了675次动脉血气分析及血清电解质检测。结果:675次血气分析中,647次(95.9%)存在不同类型的ABD。其中单纯性ABD 270次(41.7%),双重性ABD 271次(41.9%),三重性ABD 106次(16.4%)。其中,呼吸性碱中毒(RAL)404次(62.4%),代谢性酸中毒(MA)332次(51.3%),代谢性碱中毒(MAL)227次(35.1%),呼吸性酸中毒(RA)167次(25.8%)。本研究中,119例MODS患者中有79例(66.4%)死于这类ABD。结论:提示MODS早期可能存在伴有或不伴有低氧血症的RAL,后期可能出现MA甚至三重性ABD。为尽早发现并纠正原发紊乱,维持水电解质平衡很重要。治疗原发疾病也很重要。根据pH标准值纠正酸碱平衡紊乱,同时计算阴离子间隙(AG)及潜在[HCO₃⁻]。当pH大于7.50或低于7.20时,有必要给予ABD患者酸性或碱性药物以维持pH值在正常范围内。