血气分析与电解质的测定
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Transcript of 血气分析与电解质的测定
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HH2CO3 H2CO3
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H: HCO3; NaHCO3
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H+H+pH 7.35~7.45H+
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pHO2CO2
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(pH)(pCO2)(pO2) ABSB
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pH H pH < 7.35 pH > 7.45 7.35~7.45pHlg [H+]
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pHEEE
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1.5%98.5%PO2 HbSO2 HbHb1Hb4O21gHb1.34~1.39mlO2
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clark () Ag/AgCl
pO2
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O2 + 2 H2O H2O2 H2O2 + 2 e- 2 OH- PO2O2O2(-)0.4-0.8V
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1PO2
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7%23%70%PCO2 (Actual bicarbonateAB)HCO3(Standard bicarbonateSB)(T 37PaCO2 40mmHgSaO2 100%)HCO3
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pCO2Severinghaus
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PCO2 CO2 PCO2 PCO2 PCO2 PCO2
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HCO3AB=SB = AB=SB ABSB CO2 ABSB CO2ABSB
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buffer base,BB(HCO3-Hb-HPO42-) 45 ~ 55 mmol/L
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base excessBE37PCO25.32kPa40mmHg100%1LpH7.40 -3.0 ~ +3.0mmol/L BE BEHCO3- HCO3-
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anion gap,AGAGNaCl-HCO3- 140 104 2412 mmol/LPr-,HPO4-,SO4-K+,Mg2+,Ca2+ 10 ~ 14 mmol/L
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1AG []AGCl- [(HCO3-)]2
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PaCO2 PaCO2 HCO3- HCO3-
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metabolic acidosisHCO3-pHpH = Pka + lg [HCO3-] [H2CO3]pH
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11 22 12 3 43 4 5
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respiratory acidosisCO2CO2PaCO2pH CO2
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metabolic alkalosisHCO3-pHpH = Pka + lg [HCO3-] [H2CO3]pH
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11 2H+ 2 1 2 3 34
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HCO3-HCO3-Na-HHCO3-Cl-H HHHCl- Cl-Cl-Cl-HHHCO3-H2O CO2HCO3-CO2 H2OCl-HCO3-Cl -HCO3-Cl -Cl -HCO3-HCO3-Cl-
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respiratory alkalosis CO2PaCO2pHCO2
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pHH2CO3HCO3- (N) (N)
(N) (N)
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pHH2CO3HCO3- (N)
(N)
(N) (N) (N)
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pHH2CO3HCO3-
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1
2AGAG = Na+ (HCO3- + Cl-)345AG
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1pH pH 2pH 1 2 3pH (HCO3-)(PaCO2)PH 7.34HCO3- 15mmol/LPaCO2
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1 (1) or (2)PaCO2HCO3- PaCO2HCO3-
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((1)(2)
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AGAG
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-pH7.2PCO2 40mmHg HCO3- 15mmol/LpH7.2PCO2 70mmHg HCO3- 15mmol/L
+5 +10 +15 +20 +25 +30
6.9 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7
140 120 100 90 80 70 60 50 40 35 30 25 20
pH
H+nmol/L
-30
20.0
19.0
18.0
17.0
16.0
15.0
14.0
13.0
12.0
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.5
3.0
2.5
2.0
1.5
150
140
130
120
110
100
90
80
70
60
50
40
35
30
25
20
15
PCO2
(mmHg) (kPa)
(mmol/L)
-20
-15
-10
-5
0
10
15
20
30
40
50
(mmol/L)
-25
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pH 7.40PCO2 90mmHgHCO3- 55mmol/L BE 27mmol/LpH
+5 +10 +15 +20 +25 +30
6.9 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7
140 120 100 90 80 70 60 50 40 35 30 25 20
pH
H+nmol/L
-30
20.0
19.0
18.0
17.0
16.0
15.0
14.0
13.0
12.0
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.5
3.0
2.5
2.0
1.5
150
140
130
120
110
100
90
80
70
60
50
40
35
30
25
20
15
PCO2
(mmHg) (kPa)
(mmol/L)
-20
-15
-10
-5
0
10
15
20
30
40
50
(mmol/L)
-25
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A B (ion selective electrode,ISE)
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11:2:
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33.5mmol/L
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12
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H+K+
3H+K+
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4hyperkalemia5.5mmol/L
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,,H+ K+
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44% 9% 47% Na135~145mmol/L
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(Na)
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145mmol/L11200~300ml
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135mmol/L2
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135~145mmol/L3
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Calcium 1 1.5~2.0%1~1.25kg 99% 1%
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2
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3 : 2.25~2.58mmol/L : 1.10~1.34mmol/L4D1,25-(OH)2-D3(parathyroidhormone,PTH)(calcitonin,CT)
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5 VitD
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6 VitD
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95~105mmol/L
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1 1%600~800g 86% 14%
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2
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VitD VitD 3
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K+Na+Cl- K+Na+Cl-