868例危重患者碱中毒的分析

Clinical analysis of alkalosis in 868 critically ill patients

目的 :探讨危重患者碱中毒类型、特点及原因。方法 :分析了 86 8例危重患者 1470例次动脉血气、血电解质参数及临床资料。结果 :危重患者碱中毒类型依次为呼吸性碱中毒 (呼碱 ,6 6 8例次 ,45 .44 % ) ,代谢性碱中毒 (代碱 ,36 2例次 ,2 4.6 3% ) ,呼碱并代碱 (2 70例次 ,18.37% ) ,呼碱型三重酸碱失衡 (10 2例次 ,6 .94% ) ,呼吸性酸中毒 (呼酸 )并代碱 (6 8例次 ,4.6 3% )。其中 773例次 Pa O2 <8k Pa(5 2 .5 9% ,1k Pa=7.5 mm Hg)。引起碱中毒原因多样。结论 :危重患者碱中毒是常见的 ,以呼碱最常见 ,常同时伴有 型呼吸衰竭。通常是既往呼吸功能正常的危重患者的原发疾病引起呼碱伴有低氧血症 ,而代碱大部分是医源性因素引起的。多脏器功能损害的危重患者可出现呼碱型三重酸碱失衡。

Objective:To explore the types,characteristics and causes of alkalosis in critically ill patients.Methods:The clinical data,1 470 determinations of arterial blood gases and electrolytes in 868 critically ill patients were analyzed.Results:The types of alkalosis were ranked as following:respiratory alkalosis (868 determinations,45 44%),metabolic alkalosis (362 determinations,24 63%),respiratory alkalosis plus metabolic alkalosis (270 determinations,18 37%),triple acidbase disorders with respiratory alkalosis (102 determinations,6 94%),and respiratory acidosis plus respiratory alkalosis (68 determinations,4 63%).PaO 2 values below 8 kPa (1 kPa=7.5 mmHg) were obtained in 773 determinations (52.59%).The mechanism associated with the occurrence of alkalosis was multifactorial in these patients.Conclusions:Alkalosis occurred frequently in critically ill patients.The most common form was respiratory alkalosis with type Ⅰ respiratory failure.The primary disease might result in respiratory alkalosis and hypoxemia in patients with normal respiratory function,and incorrect treatment seems to be responsible for the occurrence of metabolic alkalosis.Triple acidbase disorders with respiratory alkalosis may frequently appear in critically ill patients with multiple organ dysfunction.