中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
5期
523-526
,共4页
顾文华%宋志芳%李浩军%葛晓利
顧文華%宋誌芳%李浩軍%葛曉利
고문화%송지방%리호군%갈효리
急诊%危重病%酸碱失衡%阴离子间隙%潜在HCO3 -%三重酸碱失衡
急診%危重病%痠堿失衡%陰離子間隙%潛在HCO3 -%三重痠堿失衡
급진%위중병%산감실형%음리자간극%잠재HCO3 -%삼중산감실형
Acid-base disorder%Anion gap%Potential HCO3 -%Triple acid-base disorder
目的 了解急诊危重病患者酸碱失衡(acid-base disorder,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,ABD 745例(97.3％),其中单纯ABD(simple acid-base disorder,SABD)149例(20.0％),二重ABD( dual acidbase disorder,DABD)525例(70 5％),三重ABD(triple acid-base disorder,TABD) 71例(9.5％).计算阴离子间隙(anion gap,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＜0.01),第1、2、3、7天总病死率(1 4.1％、23.9％、26.8％、38.0％)也明显增高(P＜0.05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.
目的 瞭解急診危重病患者痠堿失衡(acid-base disorder,ABD)髮生率與類型.方法 前瞻性收集2008年12月至2009年3月31日上海交通大學醫學院附屬新華醫院急診搶救室危重病患者臨床資料,同步檢測動脈血氣分析與血電解質,判斷分析ABD.結果 在766例患者中,ABD 745例(97.3％),其中單純ABD(simple acid-base disorder,SABD)149例(20.0％),二重ABD( dual acidbase disorder,DABD)525例(70 5％),三重ABD(triple acid-base disorder,TABD) 71例(9.5％).計算陰離子間隙(anion gap,AG)後,TABD從12例增至71例,漏診率為83.1％(59例)；計算潛在HCO3 -後,TABD從8例增至71例,漏診率為88.7％(63例).TABD患者年齡(77.9±10.7)歲、APACHEⅡ評分(25.9 ±7.1)、MODS髮生率(22.5％)均明顯高于SABD和DABD患者(P＜0.01),第1、2、3、7天總病死率(1 4.1％、23.9％、26.8％、38.0％)也明顯增高(P＜0.05或P＜0.01).結論急診危重病患者ABD髮生率高(97.3％),計算AG與潛在HCO3 -能減少TABD漏診,年齡與APACHEⅡ評分是TABD患者預後差的主要影響因素.
목적 료해급진위중병환자산감실형(acid-base disorder,ABD)발생솔여류형.방법 전첨성수집2008년12월지2009년3월31일상해교통대학의학원부속신화의원급진창구실위중병환자림상자료,동보검측동맥혈기분석여혈전해질,판단분석ABD.결과 재766례환자중,ABD 745례(97.3％),기중단순ABD(simple acid-base disorder,SABD)149례(20.0％),이중ABD( dual acidbase disorder,DABD)525례(70 5％),삼중ABD(triple acid-base disorder,TABD) 71례(9.5％).계산음리자간극(anion gap,AG)후,TABD종12례증지71례,루진솔위83.1％(59례)；계산잠재HCO3 -후,TABD종8례증지71례,루진솔위88.7％(63례).TABD환자년령(77.9±10.7)세、APACHEⅡ평분(25.9 ±7.1)、MODS발생솔(22.5％)균명현고우SABD화DABD환자(P＜0.01),제1、2、3、7천총병사솔(1 4.1％、23.9％、26.8％、38.0％)야명현증고(P＜0.05혹P＜0.01).결론급진위중병환자ABD발생솔고(97.3％),계산AG여잠재HCO3 -능감소TABD루진,년령여APACHEⅡ평분시TABD환자예후차적주요영향인소.
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 31,2009.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 cases).Among ABD the simple acid-base disorder ( SA BD) was 149 cases ( 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 cases 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 APACHEⅡ 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 APACHEⅡ score were key factors to poor prognosis of patients with TABD.
