重型病毒性肝炎并发多重酸碱失衡的探讨

Study on multiple acid-base disorders in patients with severe viral hepatitis

本文联合运用ABD预计代偿公式、阴离子隙、潜在HCO_3^-及Cl^-分析了274例次血气和电解质测定参数。结果发现单纯ABD仅78例次(28.5％),二重ABD 101例次(36.9％),三重ABD 95例次(34.6％)。提示重肝并发多重ABD十分常见。274例次ABD中以含呼碱222例次(81.0％)最多,其次是代碱188例次(68.6％),代酸135例次(49.3％),呼酸20例次(7.3％)最少。碱血症和酸血症之比为2.43 : 1。并发混合ABD的重肝患者其各种并发症的发生率及病死率均明显高于单纯ABD患者(P<0.05,0.01)。强调在重肝抢救过程中要注意ABD尤其是多重ABD的防治。

In order to evaluate the acid-hase disorders(ABD)in patients with severe viral hepatitis correctly,274 parameters of blood gas and electrolyte were analyzed.According to the combined analysis on the pre-estimated compensatory formula(PCF).anion gap(AG).and potential bicarbonate and chlorine,there were only 78 times of single ABD(28.5%),101 times of double ABD(36.7%),and 95 times of triple ABD(34.6%),which indicates that multiple ABD was quite common in patients with severe viral hepatitis.Among various forms of ABD.respiratory al-kalosis(222 times and 81.0%)was the commonest.then metabolic alkalosis(188 times and 68.6%).metabolic acidosis(136 times and 49.3%),and respiratory acidosis(20 times and 7.3%)occupied the 2nd.3rd.and 4th position on the list.The ratio between alkalemia and acidemia was 2.43 '?1.The incidences of complications and mortality were significantly higher in patients with mixed ABD than in those with simple ABD.