Barbosa Manuela Borges Gavaza, Alves Crésio de Aragão Dantas, Queiroz Filho Hélio
Hospital Salvador, Salvador, BA.
Faculdade de Medicina, Universidade Federal da Bahia.
Rev Bras Ter Intensiva. 2006 Dec;18(4):380-4.
To review strategies of assessment of metabolic acidosis giving emphasis to the of Stewart-Fencl-Figge method versus the traditional method of Henderson-Hasselbalch.
Metabolic acidosis is a common issue in critically ill patients, an important cause of myocardial contractility depression and sensible marker of impaired tissue oxygenation. Traditionally, is evaluated by the Henderson-Hasselbalch approach in which an arterial blood sample provides information about the presence and type of acid base disturbance. However, this method is not always capable to explain the causes of the metabolic acidosis and, therefore, several studies have explored mechanisms to improve its interpretation. The Stewart-Fencl-Figge method calculated through a mathematical formula, where in addition to arterial blood gas levels, serum levels of electrolytes, lactate and albumin are used, supplies trustworthy information allowing detection of mixed metabolic abnormalities and quantification of the magnitude of each component, mainly in patients with multiple organic dysfunctions. In these individuals, the presence of unmeasured anions in the plasma is an important mechanism of metabolic acidosis and its early detection fundamental to avoid deleterious effect on the organism.
The traditional Henderson-Hasselbalch approach fails in analyzing the underlying mechanisms of metabolic acidosis and possesses many variables that intervene with its result especially in the critically ill patient. The Stewart-Fencl-Figge method offers a broader analysis of metabolic acidosis, indicating its mechanisms and guiding a better therapeutically strategy. As an alternative, the albumin-corrected and lactate-corrected anion gap seems to be as useful as the Stewart approach in identifying the unmeasured anions.
回顾代谢性酸中毒的评估策略，重点关注斯图尔特 - 芬克尔 - 菲格方法与传统的亨德森 - 哈塞尔巴尔赫方法。
代谢性酸中毒是重症患者的常见问题，是心肌收缩力降低的重要原因，也是组织氧合受损的敏感指标。传统上，通过亨德森 - 哈塞尔巴尔赫方法进行评估，即采集动脉血样本以获取有关酸碱平衡紊乱的存在及类型的信息。然而，该方法并不总能解释代谢性酸中毒的原因，因此，多项研究探索了改进其解读的机制。通过数学公式计算的斯图尔特 - 芬克尔 - 菲格方法，除动脉血气水平外，还使用血清电解质、乳酸和白蛋白水平，可提供可靠信息，有助于检测混合性代谢异常并量化各组分的程度，主要适用于患有多种器官功能障碍的患者。在这些个体中，血浆中未测定阴离子的存在是代谢性酸中毒的重要机制，早期检测对于避免对机体产生有害影响至关重要。
传统的亨德森 - 哈塞尔巴尔赫方法在分析代谢性酸中毒的潜在机制方面存在不足，且有许多变量会影响其结果，尤其是在重症患者中。斯图尔特 - 芬克尔 - 菲格方法能对代谢性酸中毒进行更全面的分析，指明其机制并指导更好的治疗策略。作为一种替代方法，白蛋白校正和乳酸校正的阴离子间隙在识别未测定阴离子方面似乎与斯图尔特方法一样有用。
