Critical Care Medicine, Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
Critical Care Medicine, Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
Clin Biochem. 2021 Oct;96:75-77. doi: 10.1016/j.clinbiochem.2021.06.005. Epub 2021 Jun 28.
In the Stewart approach, the difference between the cation and anion concentrations, especially between sodium, accounting for the majority of cations, and chloride, comprising the majority of anions, is an important factor in pH regulation. This study investigated the effect of sodium-chloride ion difference (SCD) on pH regulation comparing with those of PaCO and lactate.
Arterial blood gas samples measured at our pediatric intensive care unit of a tertiary children's hospital between January and June 2020 were included. Samples that met the following criteria were excluded: samples collected from patients taking potassium bromide and samples with lactate concentration of >25 mmol/L. From the eligible data, pH was chosen as the dependent variable and SCD, lactate, and PaCO as independent variables, and then, a multiple regression analysis was performed.
In total, 5360 samples were included. Of these, five samples were excluded according to the exclusion criteria. Finally, 5355 samples were analyzed. As the variance inflation factors were <2.0 for all three variables, there was no multicollinearity. The following model was derived: pH = 7.384 + [0.97 × SCD (mEq/L) - 0.66 × PaCO (mmHg) - 1.33 × Lac (mmol/L)] × 10 (adjusted R-squared = 0.73; P value < 0.001). Based on the standardized partial regression coefficients (β), pH was affected in the order of PaCO (β = -0.95), SCD (β = 0.72), and lactate (β = -0.33).
The prevention of SCD reduction, together with respiratory and metabolic management, is important for pH regulation.
在斯图尔特方法中，阳离子和阴离子浓度之间的差异，特别是钠离子（阳离子的主要成分）与氯离子（阴离子的主要成分）之间的差异，是 pH 值调节的一个重要因素。本研究比较了钠离子-氯离子差（SCD）与 PaCO 和乳酸对 pH 值调节的影响。
纳入了 2020 年 1 月至 6 月期间在我们的三级儿童医院儿科重症监护病房测量的动脉血气样本。排除了以下标准的样本：服用溴化钾的患者的样本和乳酸浓度>25mmol/L 的样本。从合格的数据中，选择 pH 值作为因变量，SCD、乳酸和 PaCO 作为自变量，然后进行多元回归分析。
共纳入 5360 个样本。根据排除标准，其中 5 个样本被排除。最终，分析了 5355 个样本。由于所有三个变量的方差膨胀因子均<2.0，因此没有多重共线性。得出以下模型：pH=7.384+[0.97×SCD（mEq/L）-0.66×PaCO（mmHg）-1.33×Lac（mmol/L）]×10（调整后的 R 平方=0.73；P 值<0.001）。基于标准化偏回归系数（β），pH 值受 PaCO（β=-0.95）、SCD（β=0.72）和乳酸（β=-0.33）的影响顺序。
预防 SCD 减少，以及呼吸和代谢管理，对 pH 值调节很重要。
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