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Acid base

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  • 血液中物理溶解的氧分子所产生的压力
  • 物理溶解在动脉血中的 CO2 分子所产生的张力。
  • 动脉血氧与血红蛋白结合的程度
  • 单位容积的动脉血液中所含氧的总量。包括与血红蛋白结合的氧和物理溶解的氧两个部分。
  • 血液中一切具有缓冲作用的碱性物质的总和。
  • 血浆中结合和物理溶解的 CO2 的总含量。
  • Transcript

    • 1. Blood gas analysis and acid-basic disorderDepartment of internal medicine Chen Yu
    • 2. Blood Gas Analysis Arterial blood Sea level (101.3kPa, 760mmHg) Quiet Anti-coagulate blood Inspire air (Whether O2 supply)
    • 3. Clinical Significance To evaluate respiratory failure type Ⅰ or type Ⅱ To evaluate acid-basic disorder
    • 4. How to evaluate respiratory failure?PaO2: Arterial blood oxygenic partial pressure.Normal: 95-100mmHg (12.6-13.3kPa)Estimate formula of age: PaO2=100mmHg-(age×0.33) ±5mmHg
    • 5. Hypoxia Mild: 80-60mmHg Mediate: 60-40mmHg Severe: <40mmHg
    • 6. Respiratory FailurePaO2<60mmHg respiratory failureNotice: sea level, quiet, inspire air rule off other causes ( heart disease)
    • 7. Classification of Respiratory FailurePaCO2: The carbon dioxide partial pressure of arterial bloodNormal: 35-45mmHg (4.7-6.0kPa) mean: 40mmHg
    • 8. Classification of Respiratory Failure Type Ⅰ TypeⅡPaO2 (mmHg) <60 <60PaCO2 (mmHg) ≤50 >50
    • 9. Other ParametersSaO2: Saturation of arterial blood oxygenNormal: 0.95-0.98Significance: a parameter to evaluate hypoxia, but not sensitiveODC ( Dissociation curve of oxygenated hemoglobin): “S” shape
    • 10. SaO2% PO2 Oxygen dissociation curve
    • 11. PH 2,3DPG temperature CO2 ODC to right deviation Oxygenated hemoglobin release oxygen to tissue, prevent hypoxia of the tissue. But absorbed oxygen of hemoglobin is decreased from the alveoli.Bohr effect: movement of ODC place is induced by PH.
    • 12. PA-aO2: Difference of alveoli-arterial blood oxygenic partial pressure.Normal: 15-20mmHg (<30mmHg in the old)Significance: a sensitive parameter in gas exchange
    • 13. PvO2: Oxygenic partial pressure of mixed venous blood.Normal: 35-45mmHg mean: 40mmHgSignificance: Pa-vO2 is to reflect the tissue absorbing oxygen.
    • 14. CaO2: The content of the oxygen of the arterial blood.Normal: 19-21mmol/LSignificance: a comprehensive parameter to evaluate arterial oxygen.
    • 15. Parameters in acid-basic disorder evaluation PH: negative logarithm of Hydrogen ion concentration. Normal: 7.35-7.45 mean: 7.4 〔 HCO3- 〕 PH=Pka+log 0.03PaCO2 20 = 1 6.1+log
    • 16. HCO3- (bicarbonate): SB (standard bicarbonate) AB (actual bicarbonate)SB: the contents of HCO3- of serum of arterial blood in 38℃ , PaCO2 40mmHg, SaO2 100%. Normal: 22-27mmol/L mean: 24mmol/LAB: The contents of HCO3- in actual condition. In normal person: AB=SB
    • 17.  AB and SB are parameters to reflect metabolism, regulated by kidney. Difference of AB-SB can reflect the respiratory affection on serum HCO3- . Respiratory acidosis: AB>SB Respiratory alkalosis: AB<SB Metabolic acidosis: AB = SB<Normal Metabolic alkalosis: AB=SB>Normal
    • 18. Buffer bases ( BB) : is the total of buffer negative ion of blood.BB: HCO3- hemoglobin plasma proteins HPO42- (phosphate)Normal: 45-55mmol/L mean: 50mmol/LSignificance: Metabolic acidosis: BB Metabolic alkalosis: BB
    • 19. Bases excess ( BE): the acid or bases used to regulate blood PH 7.4 . ( in 38℃ , PaCO2 40mmHg, SaO2 100%)Normal: 0±2.3 mmol/LSignificance: add acid: BE(+), BB add base: BE(-), BB
    • 20. Total plasma CO2 (T-CO2) : total content of the CO2 .Normal: HCO3- >95%
    • 21. Anion gap (AG): the difference of undetermined anion and undetermined cation in serum.AG=Na+ - (Cl-+ HCO3- )Normal: 8-16mmol/LSignificance: AG acidosis: ketoacidosis, kidney failure AG normal acidosis: Cl , diarrhea, fixed acid decrease to evaluate mix acid-basic disorder
    • 22. Regulation of Acid-basic Balance Chemical buffer Dielectric changes of incells and excells H+---K+, HCO3- ---Cl- Physiology regulation of the lung and kidney
    • 23. Classification of Acid-basic Disorder  Complementary: PH is normal  Dis-complementary: PH is abnormal.  PH,PaCO2, HCO3- are three important parameters in acid-basic disorder evaluation.
    • 24. Classification of Acid-basic Disorder PH PaCO2 HCO3-Resp. acidosisResp. alkalosisMeta. acidosisMeta. alkalosis
    • 25. Classification of Acid-basic Disorder Mixed acid-basic disorder Complementary formula example: original disorder: chronic respiratory acidosis ⊿ HCO3- =⊿ PaCO2 ×0.35±5.58 complementary limit: 45mmol/L
    • 26. Classification of Acid-basic Disorder Respiratory acidosis with metabolic acidosis Respiratory acidosis with metabolic alkalosis Respiratory alkalosis with metabolic acidosis Respiratory alkalosis with metabolic alkalosis
    • 27. Respiratory acidosis with metabolic acidosis PaCO2: HCO3- : , normal, (slight) AB, SB, BB: , normal, (slight) PH: BE: negative value
    • 28. Respiratory acidosis with metabolic alkalosis PaCO2: AB: PH: , N,
    • 29. Mixed by three types of disorder Respiratory acidosis + metabolic acidosis +metabolic alkalosis Respiratory alkalosis + metabolic acidosis +metabolic alkalosis