Bishop R L, Weisfeldt M L
JAMA. 1976 Feb 2;235(5):506-9.
Arterial pH, Pco2, and osmolality were determined serially during cardiac resuscitation in patients and in dogs, with and without administration of sodium bicarbonate. These studies demonstrate that (1) in the absence of preexisting acidosis, severe acidosis can be prevented by adequate ventilation alone; (2) sodium bicarbonate administration results in a significant rise in arterial Pco2, which parallels the rise in pH despite adequate ventilation; (3) during prolonged cardiac and resuscitation, there is a rise in arterial osmolality that is accentuated by sodium bicarbonate. These studies suggest that sodium bicarbonate should not be used during resuscitation (1) in the absence of effective hyperventilation or where carbon dioxide removal is inadequate despite adequate ventilation, (2) in repeated doses, without confirmation of substantial acidosis, or (3) when cardiac arrest has been of brief duration and preexisting acidosis is unlikely. These studies also point to the need for a reappraisal of other buffers that do not elevate the arterial Pco2.
在患者和犬类进行心脏复苏期间，无论是否给予碳酸氢钠，均连续测定动脉血pH值、二氧化碳分压（Pco2）和渗透压。这些研究表明：（1）在不存在预先存在的酸中毒情况下，仅通过充分通气即可预防严重酸中毒；（2）给予碳酸氢钠会导致动脉血Pco2显著升高，尽管通气充分，但该升高与pH值升高平行；（3）在长时间心脏骤停及复苏期间，动脉渗透压会升高，而碳酸氢钠会加剧这种升高。这些研究表明，在以下情况下复苏期间不应使用碳酸氢钠：（1）不存在有效的过度通气，或尽管通气充分但二氧化碳清除不足时；（2）重复给药且未确认存在严重酸中毒时；（3）心脏骤停持续时间较短且不太可能存在预先存在的酸中毒时。这些研究还指出，需要重新评估其他不会升高动脉血Pco2的缓冲剂。
