肝性脑病呼吸性碱中毒并发混合型酸碱失衡的诊断

Diagnosis of respiratory alkalosis compllcated bymixed acld-base disturbance in hepatic encephalopathy

１６９例肝性脑病４９８例次动脉血气和血电解质研究结果表明，运用呼碱和代碱预计代偿公式，可对肝性脑病呼碱并发混合型酸碱失衡作出正确的判断。凡符合实例正常可判断为呼碱并代酸；实测正常，可判断为呼碱并代碱；呼碱伴ＡＧ升高，实测正常，可判断为呼碱型三重酸碱失衡。呼碱ＰａＣＯ＿２＜４．６７ｋＰａ时，机体尽管发挥了最大的代偿能力，也不能使ｐＨ恢复正常。酸碱失衡预计代偿公式能对不同ＰａＣＯ＿２水平提供不同的判断结果。公式计算简单，便于临床应用。

The parameters of 498 arterial blood gas andeleclrolyte measurements in 169 patients with hepaticencephalopathy were analyzed.Theresult showedthat correct diagnosis of respiratory alkalosis associ-ated with mixed acid-base disturbance in hepaticencephalopathy could be made with the use ofpreestimated compensatory formulas (PCF) forrespiratory and metobolic alkalosis.if the actualHCO_3is< normal HCO_3+0.5×△ PaCO_2-2.5,respiratory alkalosis complieated by metabolicacidosls can be diagnosed.If the actual HCO_3 iS>normal HCO_3+0.5×△PaCO_2+2. 5,respiraloryalkalosis with metabolic alkalosis can be dlagnosed.Ifrespiralory alkalosis is associated with elevated aniongap (A and the actual HCO_3+△AG is >normalHCO_3+0.5×△ PaCO_2+2.5,triple acid-base disturb-ance can be diagnosed.Irrcspective of maximal com-pensalion of the body, pH cannot relurn to normalwhen respiratory alkalosis is associated with aPaCO_2less than 4.67kPa.The PCF of acid-base canprovide different results to different PaCO_2levels,and is simple and convenient for clinical use.