Kishen R, Honoré Patrick M, Jacobs R, Joannes-Boyau O, De Waele E, De Regt J, Van Gorp V, Boer W, Spapen Hd
Intensive Care Unit, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK (formerly) ; Translational Medicine and Neurosciences, University of Manchester, Manchester, UK.
Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Int J Nephrol Renovasc Dis. 2014 Jun 4;7:209-17. doi: 10.2147/IJNRD.S62126. eCollection 2014.
Acid-base disorders are common in the critically ill. Most of these disorders do not cause harm and are self-limiting after appropriate resuscitation and management. Unfortunately, clinicians tend to think about an acid-base disturbance as a "disease" and spend long hours effectively treating numbers rather than the patient. Moreover, a sizable number of intensive-care physicians experience difficulties in interpreting the significance of or understanding the etiology of certain forms of acid-base disequilibria. Traditional tools for interpreting acid-base disorders may not be adequate for analyzing the complex nature of these metabolic abnormalities. Inappropriate interpretation may also lead to wrong clinical conclusions and incorrectly influence clinical management (eg, bicarbonate therapy for metabolic acidosis in different clinical situations). The Stewart approach, based on physicochemical principles, is a robust physiological concept that can facilitate the interpretation and analysis of simple, mixed, and complex acid-base disorders, thereby allowing better diagnosis of the cause of the disturbance and more timely treatment. However, as the concept does not attach importance to plasma bicarbonate, clinicians may find it complicated to use in their daily clinical practice. This article reviews various approaches to interpreting acid-base disorders and suggests the integration of base-excess and Stewart approach for a better interpretation of these metabolic disorders.
酸碱紊乱在危重症患者中很常见。这些紊乱大多不会造成损害，在适当的复苏和处理后具有自限性。不幸的是，临床医生倾向于将酸碱紊乱视为一种“疾病”，花费大量时间去有效处理数值而非患者本身。此外，相当一部分重症监护医生在解释某些形式的酸碱失衡的意义或理解其病因方面存在困难。用于解释酸碱紊乱的传统工具可能不足以分析这些代谢异常的复杂本质。不恰当的解释还可能导致错误的临床结论，并错误地影响临床管理（例如，在不同临床情况下对代谢性酸中毒进行碳酸氢盐治疗）。基于物理化学原理的斯图尔特方法是一个强大的生理学概念，它可以促进对单纯性、混合性和复杂性酸碱紊乱的解释和分析，从而更好地诊断紊乱的原因并进行更及时的治疗。然而，由于该概念不重视血浆碳酸氢盐，临床医生可能会发现在日常临床实践中使用它很复杂。本文回顾了各种解释酸碱紊乱的方法，并建议将碱剩余和斯图尔特方法结合起来，以更好地解释这些代谢紊乱。
