Fukui T
SONY Wellness Center.
Nihon Rinsho. 1992 Sep;50(9):2077-81.
In 1874, Kussmaul described "featiful terminal dyspnea" in a case of severe diabetic coma. Probably, this was the first sign of respiratory regulation for metabolic acidosis. After this first case, about 40 years has been needed to establish the theory of acid-base equiribration, namely Henderson-Hasselbalch's equation. pH = 6.1 + log [HCO3-]/[H2CO3] This equation indicates that plasma pH is determined by the ratio of HCO3 concentration and H2CO3 concentration. Because of linear relationship between H2CO3 and PaCO2, pH depend on the ratio of HCO3- and PaCO2. In the state of metabolic acidosis, increase of [H+] stimulates ventilation and decreases the PaCO2. Inversely, in the state of metabolic alkalosis, increase of PaCO2 occurs. These reactions are called "respiratory compensation" or "respiratory regulation". The respiratory regulation system will not retern pH to normal (7.4), but compensation has some limitation which is shown as "SIGNIFICANCE BAND". In this paper, physiological and clinical importance of respiratory regulation and significance band is discussed.
1874年，库斯莫尔描述了一例严重糖尿病昏迷患者出现的“临终前呼吸困难”。这可能是代谢性酸中毒呼吸调节的首个迹象。在这首例病例之后，大约经过40年才确立了酸碱平衡理论，即亨德森-哈塞尔巴尔赫方程。pH = 6.1 + log [HCO₃⁻]/[H₂CO₃] 该方程表明血浆pH值由HCO₃浓度与H₂CO₃浓度的比值决定。由于H₂CO₃与PaCO₂之间存在线性关系，pH值取决于HCO₃⁻与PaCO₂的比值。在代谢性酸中毒状态下，[H⁺]升高刺激通气并降低PaCO₂。相反，在代谢性碱中毒状态下，会出现PaCO₂升高。这些反应被称为“呼吸代偿”或“呼吸调节”。呼吸调节系统不会使pH值恢复正常（7.4），但代偿存在一定限度，表现为“意义带”。本文讨论了呼吸调节和意义带的生理及临床重要性。
