中暑的代谢与呼吸改变。

The metabolic and respiratory alterations of heat stroke.

作者信息

Sprung C L, Portocarrero C J, Fernaine A V, Weinberg P F

出版信息

Arch Intern Med. 1980 May;140(5):665-9.

Abstract

The metabolic and respiratory changes of 21 patients with heat stroke were studied. Admission arterial blood gas levels were measured, and serum bicarbonate, lactate, calcium, phosphorus, and anion gap determinations were performed. Seven patients had a metabolic acidosis (pH 7.20 +/- 0.04, PCO2 32 +/- 2 mm Hg, and bicarbonate 12 +/- 1 mEq/L), seven a combined metabolic acidosis and respiratory alkalosis (pH 7.39 +/- 0.01, PCO2 25 +/- 1 mm Hg, and bicarbonate 15 +/- 1 mEq/L), four a respiratory alkalosis (pH 7.45 +/- 0.01, PCO2 30 +/- 1 mm Hg, and bicarbonate 20 +/- 1 mEq/L), one a metabolic and respiratory acidosis (pH 7.13, PCO2 52 mm Hg, and bicarbonate 17 mEq/L), and one a respiratory acidosis (pH 7.30, PCO2 56 MM Hg, and bicarbonate 27 mEq/L). The 15 patients with a metabolic acidosis had a pH of 7.28 +/- 0.03, PCO2 of 30 +/- 2 mm Hg, bicarbonate level of 14 +/- 1 mEq/L, lactate concentration of 6.5 +/- 1.0 mEq/L, and an anion gap of 26 +/- 4 mEq/L. Nine patients were hypocalcemic (7.8 +/- 0.3 mg/dL), and five patients were hypophosphatemic (2.0 +/- 0.2 mg/dL). The predominant metabolic change in heat stroke is a metabolic acidosis secondary to increased lactate content and/or a respiratory alkalosis. Hypocalcemia is common and hypophosphatemia is not infrequent.

摘要

对21例中暑患者的代谢和呼吸变化进行了研究。测定了入院时的动脉血气水平，并进行了血清碳酸氢盐、乳酸、钙、磷和阴离子间隙测定。7例患者存在代谢性酸中毒（pH 7.20±0.04，PCO2 32±2 mmHg，碳酸氢盐12±1 mEq/L），7例存在混合性代谢性酸中毒和呼吸性碱中毒（pH 7.39±0.01，PCO2 25±1 mmHg，碳酸氢盐15±1 mEq/L），4例存在呼吸性碱中毒（pH 7.45±0.01，PCO2 30±1 mmHg，碳酸氢盐20±1 mEq/L），1例存在代谢性和呼吸性酸中毒（pH 7.13，PCO2 52 mmHg，碳酸氢盐17 mEq/L），1例存在呼吸性酸中毒（pH 7.30，PCO2 56 mmHg，碳酸氢盐27 mEq/L）。15例代谢性酸中毒患者的pH为7.28±0.03，PCO2为30±2 mmHg，碳酸氢盐水平为14±1 mEq/L，乳酸浓度为6.5±1.0 mEq/L，阴离子间隙为26±4 mEq/L。9例患者低钙血症（7.8±0.3 mg/dL），5例患者低磷血症（2.0±0.2 mg/dL）。中暑时主要的代谢变化是继发于乳酸含量增加的代谢性酸中毒和/或呼吸性碱中毒。低钙血症常见，低磷血症也不少见。