内科重症感染并发多脏器衰竭的酸碱失衡(附65例临床分析)

Acid-base balance disturbance in severe infections complicated with MSOF:clinical ananlysis of 65 cases/

对65例感染并发多脏器衰竭(MSOF)患者发病初与治疗后的酸碱失衡类型进行了分析,结果提示:本组患者治疗前的复合失衡发生率为68%,其中二重失衡为43%,三重失衡为25%。原发失衡以代酸为主,其中包括高AG代酸和正常AG的高氯性代酸,后者多见于急性肾功能衰竭患者。将本组患者分为死亡组与生存组进行统计学处理,发现治疗前两组的单纯失衡与复合失衡无差异,治疗后生存组表现为单纯失衡增加,复合失衡减少,与死亡组差异显著。死亡组临终前多为伴呼酸的各种复合失衡。因此,对感染性NSOF患者在发病初就要注意正确判别其酸碱平衡类型,着重去除发生代酸的因素,除积极处理原发病以外,要有效地纠正低氧血症,早期行活血化瘀治疗,改善肝、肾等重要脏器微循环灌注,同时辅以小剂量碱性药。

In this paper,acid-base balance disorders in 65 caseswith MSOF weres analyzed.The result showed that mixedacid-base disorders occurred in 68% of the cases beforetreatments.Double imbalance was found in 43% andtriple disorders in 25%.Acid-base imbalance usuallystarted with acidosis(principally metabolic acicdsis),in-cluding high AG and normal AG with high chloride aci-dosis.The occurrence of single acid-base disturbance andmixed acid-base disturbancl was signifcantly different inpercentage in patients who survived the infection in(?)parison with the patients who died of the disease.This in-dicated that fatal outcome was often assotiated with thedevelopment of mixed disturbance.Mixed disorders withrespiratory acidosis and uncompensatory metabolic acido-sis were usually found in the terminal stage of the infec tion.For effective treatment,it is crucial to make an earlydiagnosis of acid-base imbalance,especially the mixedtype.Emphasis must be put on removal of the predispos-ing factors such as hypoxemia,renal and hepatic failureand coagulation disturbance.