Dubitskiĭ A E, Chepkiĭ L P, Butylin V Iu, Tsertiĭ V P, Detsenko E A
Anesteziol Reanimatol. 1992 Sep-Dec(5-6):50-3.
It has been established that in conditions of intraoperative blood and plasma loss base deficiency is determined not only by hypocarbonatemia, but also by hypoproteinemia, hypophosphatemia and HCO3 metabolism disturbances caused by anemia. Correction of metabolic acidosis in such patients should include infusions of NaHCO3, protein preparations, blood, phosphates. Mellemgaard and Astrup's technique presupposes correction of the deficiency of all buffer bases only with NaHCO3, which dramatically increases its dosage. Thus, it is evident that the technique should be revised. The comparison of the results of metabolic acidosis correction using a conventional and adapted techniques (hydrocarbonate dose in mmol or ml of a 8.4% solution is 24-SB.body weight.0.2%) in statistically homogeneous groups has shown that differentiated "polybuffer" correction of metabolic acidosis with adapted NaHCO3 dose 1.7 times more frequently normalized acid-base balance parameters, reducing the risk of the onset of post-correction metabolic alkalosis to minimum.
已经确定，在术中失血和血浆丢失的情况下，碱缺乏不仅由低碳酸血症决定，还由低蛋白血症、低磷血症以及贫血引起的HCO3代谢紊乱决定。此类患者代谢性酸中毒的纠正应包括输注碳酸氢钠、蛋白质制剂、血液和磷酸盐。Mellemgaard和Astrup的技术仅预设用碳酸氢钠纠正所有缓冲碱的缺乏，这会显著增加其用量。因此，显然该技术应予以修订。在统计学上同质的组中，使用传统技术和改良技术（8.4%溶液的碳酸氢盐剂量以mmol或ml计为24 - SB×体重×0.2%）纠正代谢性酸中毒结果的比较表明，采用调整后的碳酸氢钠剂量进行差异化的“多缓冲剂”代谢性酸中毒纠正，使酸碱平衡参数正常化的频率高出1.7倍，将纠正后代谢性碱中毒的发生风险降至最低。
