内环境紊乱的认识与纠正中的误区

Erroneous cognition of the treatment of internal environment disturbance

目的在临床工作中,由于对内环境紊乱认识上的错误,在纠治过程中常出现以下误区:①AG增大都缘于代谢性酸中毒。②救治糖尿病酮症酸中毒,滥用碳酸氢钠;未补充血容量先给胰岛素;无序补钾。③大通气量纠正慢性呼吸性酸中毒。④心肺复苏一律给予碳酸氢钠。⑤治疗低血钠只看[Na+],不结合临床表现快速补钠。⑥不区别抗利尿激素不当分泌综合征与脑耗盐综合征,盲目补充氯化钠。⑦只注意低血钾致心律失常而忽视其抑制呼吸和加重肝性脑病的危险性。⑧忽视治疗所引起的K+向细胞内转移而致低血钾。⑨无区别地固守补钾速度KCl<1g/h的习用原则。本文将上述误区出现的原因进行了分析并提出正确的解决方法。

There are some erroneous cognitions in the treatments of the internal environment disturbance ：including ①wide AG only to imply metabolic acidosis.②to abuse NaHCO3 for diabetic ketoacidosis（DKA）;to give insulin before reexpansion;to supply potassium in out of order.③to correct chronic respiratory acidosis with hyperventilation.④to abuse NaHCO3 in CPR.⑤to supply Na＋ rapidly for chronic hyponatremia,regardless of the patient＇s conditions.⑥to supply NaCl without distinguishing between syndrome of inappropriate antidiuretic hormone and cerebral salt wasting syndrome.⑦to neglect the danger of the inhibition of the respiration and exacerbation of hepatic encephalopathy from the hypokalemia.⑧to ignore the hypokalemia caused by some treatments.⑨to rigidly follow the habit：supplement of KCl〈1 g/h.The writer analyzes the reason of erroneous cognitions and gives some advices.