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慢性低碳酸血症时酸碱平衡的调节。肾脏的反应并非旨在维持细胞外(氢离子)平衡的证据。

Regulation of acid-base equilibrium in chronic hypocapnia. Evidence that the response of the kidney is not geared to the defense of extracellular (H+).

作者信息

Cohen J J, Madias N E, Wolf C J, Schwartz W B

出版信息

J Clin Invest. 1976 Jun;57(6):1483-9. doi: 10.1172/JCI108418.

Abstract

It is generally believed that the reduction in plasma [HCO3] characteristic of chronic hypocapnia results from renal homeostatic mechanisms designed to minimize the alkalemia produced by.the hypocapneic state. To test this hypothesis, we have induced chronic hypocapnia in dogs in which plasma [HCO3] had previously been markedly reduced (from 21 to 15 meq/liter) by the prolonged feeding of HCl. The PaCO2 of chronically acid-fed animals was reduced from 32 to 15 mm Hg by placing the animials in a large environmental chamber containing 9% oxygen. In response to this reduction in PaCO2, mean plasma [HCO3] fell by 8.6 meq/liter, reaching a new steady-state level of 6.4 meq/liter. This decrement in plasma [HCO3] is almost identical to the 8.1 meq/liter decrement previously observed in normal (nonacid-fed) animals in which the same degree of chronic hypocapnia had been induced. Thus, in both normal and HCl-fed animals, the renal response to chronic hypocapnia causes plasma [HCO3] to fall by approximately 0.5 meq/liter for each millimeter of Hg reduction in CO2 tension. By contrast, the response of plasma [H+] in the two groups was markedly different. Instead of the fall in [H+] which is seen during chronic hypocapnia in normal animals, [H+] in HCl-fed animals rose significantly from 53 to 59 neq/liter (pH 7.28-7.23). This seemingly paradoxical response is, of course, an expression of the constraints imposed by the Henderson equation and reflects the fact that the percent fall in [HCO3] in the HCl-fed animals was greater than the percent fall in PaCO2. These findings clearly indicate that in chronic hypocapnia the kidney cannot be regarded as the effector limb in a homeostatic feedback system geared to the defense of systemic acidity.

摘要

一般认为,慢性低碳酸血症所特有的血浆[HCO₃]降低是由于肾脏的稳态机制所致,该机制旨在将低碳酸血症状态所产生的碱血症降至最低。为了验证这一假说,我们在犬身上诱发了慢性低碳酸血症,这些犬的血浆[HCO₃]此前因长期喂食盐酸而显著降低(从21降至15毫当量/升)。通过将动物置于含有9%氧气的大型环境舱中,使长期喂食酸的动物的动脉血二氧化碳分压(PaCO₂)从32降至15毫米汞柱。作为对PaCO₂降低的反应,平均血浆[HCO₃]下降了8.6毫当量/升,达到了6.4毫当量/升的新稳态水平。血浆[HCO₃]的这种下降几乎与先前在正常(未喂食酸)动物中观察到的8.1毫当量/升的下降相同,在这些正常动物中诱发了相同程度的慢性低碳酸血症。因此,在正常动物和喂食盐酸的动物中,肾脏对慢性低碳酸血症的反应都会使血浆[HCO₃]因二氧化碳分压每降低1毫米汞柱而下降约0.5毫当量/升。相比之下,两组中血浆[H⁺]的反应明显不同。正常动物在慢性低碳酸血症期间会出现[H⁺]下降,而喂食盐酸的动物的[H⁺]则从53显著升至59纳当量/升(pH从7.28降至7.23)。这种看似矛盾的反应当然是亨德森方程所施加限制的一种表现,反映了喂食盐酸的动物中[HCO₃]下降的百分比大于PaCO₂下降的百分比这一事实。这些发现清楚地表明,在慢性低碳酸血症中,肾脏不能被视为旨在维持全身酸度的稳态反馈系统中的效应器环节。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c9ca/436807/86be48caa7f8/jcinvest00149-0098-a.jpg

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