并用人工肾与膜式人工肺治疗呼吸性酸中毒合并代谢性碱中毒的实验研究

Artificial kidney and membrane oxygenator in treatment of respiratory acidosis associated with metabolic alkalosis:Laboratory investigation

寻求迅速改善呼吸性酸中毒合并代谢性碱中毒患者机体的自稳态，使pH值很快得以纠正的治疗方法。应用中空纤维人工肾，选择低HCO_3^-透析液，利用透析液与血液间HCO_3^-浓度梯度的不同，将血液中过多的HCO_3^-透析出去；同时将透析器与微孔聚丙烯膜式人工肺合并应用，排出过多的CO_2增加动脉血的氧分压（PO_2）。结果：经转流30，60，90和120分钟与转流前比较，HCO_3^-、二氧化碳分压（PCO_2）、PO_2均有明显差异（P＜0．05或＜0．01）。提示：并用人工肾与膜式人工肺是治疗呼吸性酸中毒合并代谢性碱中毒的一个新的治疗方法。

This study aimed at seeking an approach to therapid correction of abnormal pH by quickly improvingthe homeostasis of the patients with respiratory acidosisassociated with metabolic alkalosis. Using hollowfiber artificial kidney,we selected the dialytic solutionlow in HCO_3^- concentration in the experiment. Becauseof the difference between the HCO_3^- concentrationgradients in the dialytic solution and blood,the excessiveHCO_3^- was dialyzed out of the blood. In the presentstudy,a system consisting of a hemodialyzer and amicroporous polypropylene membrane oxygenator wasuser to remove the excessive canbon dioxide and to increasethe arterial oxygen partial pressure (PaO_2). Theresults after transferring for 30', 60', 90' and 120' werecompared with those before transference. There was anevident difference between the levels of arterial HCO_3^-,PaO_2, PaCO_2 before and after transference (P<0.01, P<0. 05).This is a new treatment of respiratory acidosisassociated with matabolic alkalosis