急诊危重病患者酸碱失衡发生率与类型

The incidence and types of acid-base disorder of critically ill patients in emergency

目的了解急诊危重病患者酸碱失衡（acid—basedisorder，ABD）发生率与类型。方法前瞻性收集2008年12月至2009年3月31日上海交通大学医学院附属新华医院急诊抢救室危重病患者临床资料，同步检测动脉血气分析与血电解质，判断分析ABD。结果在766例患者中，ABD745例（97．3％），其中单纯ABD（simpleacid—basedisorder，SABD）149例（20．0％），二重ABD（dualacid—basedisorder。DABD）525例（70．5％），三重ABD（tripleacid—basedisorder，TABD）71例（9．5％）。计算阴离子间隙（aniongap，AG）后，TABD从12例增至71例，漏诊率为83．1％（59例）；计算潜在HCO3-后，TABD从8例增至71例，漏诊率为88．7％（63例）。TABD患者年龄（77．9±10．7）岁、APACHEⅡ评分（25．9±7．1）、MODS发生率（22．5％）均明显高于SABD和DABD患者（P〈n01），第1、2、3、7天总病死率（14．1％、23．9％、26．8％、38．0％）也明显增高（P〈n05或P〈0.01）。结论急诊危重病患者ABD发生率高（97．3％），计算AG与潜在HCO3-能减少TABD漏诊，年龄与APACHEⅡ评分是TABD患者预后差的主要影响因素。

Objective To reveal the incidence and types of acid-base disorder （ABD） of critically ill patients in emergency. Methods The clinical data of critically ill patients in the resuscitation room were collected prospectively from December 1, 2008 to March 31, 21309. Both arterial and venous blood samples were collected to detect arterial blood gas analysis and serum electrolytes simultaneously and their ABD were analyzed. Results Of totally 766 cases, the incidence of ABD was 97. 3% （745 eases）. Among ABD the simple acid-base disorder （SABD） was 149 eases （20. 0% ）, dual acid-base disorder （DABD） 525 （70. 5% ） and triple acid-base disorder （TABD） 71 （9. 5% ）. After calculating anion gap （AG）, the incidence of TABD increased from 12 to 71 eases and the missed diagnosis rate were 83. 1% （59 cases） and after calculating potential HCO3-, the incidence of TABD increased from 8 to 71 cases and the missed diagnosis rate were 88. 7% （63 cases）. The age of patients with TABD （77. 9 ± 10. 7 years old） was older （P 〈0. 01 ） than that of other two groups of SABD and DABD as well as APACHEH score （25. 9 ±7. 1 ） and incidence （22. 5% ） of MODS in TABD were higher （P 〈 0.01）. The mortality of patients with TABD on the first, second, third and seven day were 14. 1%, 23.9%, 26. 8% and 38. 0% respectively and significantly higher than those in SABD and DABD （P 〈0. 05 or P 〈0. 01 ）. Conclusions The incidence of ABD was 97. 3%. Calculation of AG and potential HCO3- would help find metabolic acidosis and TABD. The age and APACHEH score were key factors to poor prognosis of patients with TABD.