Pytte M, Opdahl H, Skaga N O
Department of Anaesthesiology, Ullevål University Hospital, Oslo, Norway.
Acta Anaesthesiol Scand. 2007 Apr;51(4):495-500. doi: 10.1111/j.1399-6576.2006.01223.x. Epub 2007 Jan 12.
In a 20-year-old woman with known asthma, anaphylactic bronchospasm induced a grave combined respiratory and metabolic acidosis (pH(a) 6.66) with marked hypoxaemia (S(a)O(2) 45%). The beneficial effects of the rightward shift of the oxyhaemoglobin dissociation curve on tissue O(2) unloading at such pH was more than offset by the negative effect on S(a)O(2) at the reduced P(a)O(2) (7.0 kPa) found in this patient. This case illustrates the detrimental effect of grave acidosis on arterial blood oxygen content at subnormal P(a)O(2) values, the beneficial effect of a supranormal P(a)O(2) on the S(a)O(2) in such patients, and the rapid remission rate of life-threatening acidosis and blood lactate after adequate ventilation and tissue oxygenation were secured. The initial treatment of the patient and clinically relevant considerations are discussed.
在一名患有已知哮喘的20岁女性中，过敏性支气管痉挛引发了严重的呼吸和代谢性酸中毒（动脉血pH值6.66），伴有明显的低氧血症（动脉血氧饱和度45%）。在此pH值下，氧合血红蛋白解离曲线右移对组织氧卸载的有益作用，被该患者降低的动脉血氧分压（7.0 kPa）时对动脉血氧饱和度的负面影响所抵消。该病例说明了严重酸中毒对低于正常动脉血氧分压值时动脉血氧含量的有害影响，超常的动脉血氧分压对此类患者动脉血氧饱和度的有益作用，以及在确保充分通气和组织氧合后危及生命的酸中毒和血乳酸的快速缓解率。讨论了该患者的初始治疗及临床相关注意事项。
