Brimioulle S, Berre J, Dufaye P, Vincent J L, Degaute J P, Kahn R J
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Crit Care Med. 1989 Mar;17(3):232-6. doi: 10.1097/00003246-198903000-00006.
Hypercapnia due to respiratory failure can be more severe when accompanied by coexistent metabolic alkalosis. We therefore tested the hypothesis that hydrochloric acid (HCl) infusion could improve PaCO2 in 15 critically ill patients admitted with mixed respiratory acidosis and metabolic alkalosis, and a pH of between 7.35 and 7.45. HCl was infused at a constant rate of 25 mmol/h until the bicarbonate concentration decreased less than 26 mmol/L, or until the pH decreased less than 7.35 (initial pH greater than 7.40) or 7.30 (initial pH less than 7.40). Administration of 170 +/- 53 mmol of HCl decreased the bicarbonate concentration from 34 +/- 3 to 25 +/- 2 mmol/L (p less than .001), the pH from 7.41 +/- 0.03 to 7.33 +/- 0.02 (p less than .001), and the PaCO2 from 54 +/- 8 to 48 +/- 8 torr (p less than .001). Postinfusion PaCO2 could be predicted accurately from the initial status of the patients (r = .95, p less than .001) except in one patient with fixed hypercapnia. PaCO2 increased from 77 +/- 19 to 94 +/- 24 torr (p less than .001) and PaO2/PAO2 increased from 59 +/- 17 to 66 +/- 17% (p less than .001). The effects of HCl were still present 12 h after the end of the infusion. No complications related to the acid infusion were noted. These results indicate that, even in the absence of alkalemia, active correction of metabolic alkalosis by HCl infusion can improve CO2 and oxygen exchange in critically ill patients with mixed respiratory acidosis and metabolic alkalosis.
呼吸衰竭所致的高碳酸血症若伴有代谢性碱中毒，病情可能会更严重。因此，我们检验了这样一个假设：对于15例因混合性呼吸性酸中毒和代谢性碱中毒入院、pH值在7.35至7.45之间的危重症患者，输注盐酸（HCl）可改善动脉血二氧化碳分压（PaCO2）。以25 mmol/h的恒定速率输注HCl，直至碳酸氢盐浓度下降至低于26 mmol/L，或直至pH值下降至低于7.35（初始pH值大于7.40）或7.30（初始pH值小于7.40）。输注170±53 mmol的HCl后，碳酸氢盐浓度从34±3 mmol/L降至25±2 mmol/L（p<0.001），pH值从7.41±0.03降至7.33±0.02（p<0.001），PaCO2从54±8 torr降至至48±8 torr（p<0.001）。除1例存在持续性高碳酸血症的患者外，输注后PaCO2可根据患者的初始状态准确预测（r = 0.95，p<0.001）。PaCO2从77±19 torr升至94±24 torr（p<0.001），动脉血氧分压与肺泡氧分压比值（PaO2/PAO2）从59±17%升至66±17%（p<0.001）。输注结束12小时后，HCl的作用仍然存在。未发现与酸输注相关的并发症。这些结果表明，即使不存在碱血症，通过输注HCl积极纠正代谢性碱中毒也可改善混合性呼吸性酸中毒和代谢性碱中毒的危重症患者的二氧化碳和氧交换。
