Добавил:
Upload Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:

Костюченко С.С. - Кислотно-щелочной баланс в интенсивной терапии. 2008

.pdf
Скачиваний:
76
Добавлен:
12.03.2016
Размер:
1.73 Mб
Скачать

-

;

-

.

, -

-

. -

, -

;

22 , 2-

,

,

30 - 45º

. 29);

, -

;

-

;

. 29. .

-

5 , -

;

,

, FiO2 -

.

.

: .

: -

, , -

-

, , -

.

: -

-

( ),

( , -

, ),

-

.

:

;

-

: -

-.

,

( . . 27);

1-2 .

;

22 , 2-

,

,

45º

.

-

,

161

. .

-

-

. -

-

.

:

,

1 -

;

15-20 -

.

. 27. .

., . ., . . -

-

.

.

.

. PO2

150 . .,

PaO2 80 -110

. . -

, -

-

, -

PaO2. -

PaO2

, PO2 ,

620 . . 100 -

.

PaO2 -.

– PCO2

, PaCO2 -

35 – 45 . .

-

PaCO2 , ,

PaCO2 ,

.

-

.

, ,

.

,

-

.

-

-

.

.

-

.

»

PaCO2, pH,

162

PaO2. -

-

,

, -

.

, -

, -

.

40×109 -

1000×109.

,

-

. -

PaCO2 .

, -

, -

.

. ( -

)

-

, -

. -

1 -

, -,

,

-

.

PaCO2 3 – 10 . ., -

pH.

1 .

.

-

, -

-

-

-

,

. -

-

, , -

. -

-

-

. -

-

, -

. -

-

– PO2 150 . ., PCO2 0,3 . ., -

. -

-

( -

). -

. -

0,1 1-2

5%.

-

, -

.

-

, -

.

.

-

-

,

, , ,

. ).

163

. .

.

-

– 5

.

. , -

-

. -

, -

( . « »).

.

PaO2

, .

.

-

. -

ABG

37º .

« »

-

.

-

. -

. PaO2 PaCO2 , pH .

37º PaO2 -

7,2% , PaCO2

4,4%. - ,

, -

, -

PaO2 PaCO2 -

pH.

37º

PaO2 7,2%. -

ABG -

-

. -

t > 39ºC.

16.

pH , PaCO2 PaO2 ( . , 2002)

 

pH

PaCO2

PaO2

, º .

 

 

 

43

-0,09

+22

+35

41,5

-0,07

+17

+27

41

-0,06

+16

+25

40,5

-0,05

+14

+22

40

-0,04

+12

+19

39,5

-0,04

+10

+16

39

-0,03

+8

+13

38,5

-0,02

+6 ,

+10

38

-0,01

+4

+7

37

 

 

 

36

0,01

-4

-7

35,5

0,02

-6

-10

35

0,03

-8

-13

34,5

0,04

-10

-16

34

0,04

-12

-19

33,5

0,05

-14

-22

33

0,06

-16

-25

32

0,07

-19

-30

31

0,09

-22

-35

30

0,10

-26

-39

29

6,12

-29

-43

28

0,13

-32

-47

26

0,15

-36

-53

24

0,19

-43

-60

.

164

,

( -

pH) -

.

, -

. -

, -

-

.

, -

.

-

, -

-

.

ABG -

,

.

, ,

,

-

15 – 20

.

-

10 ,

PaO2.

-, .

– ,

, .

,

,

( ,

) .

, 1

. ,

: ,

, ,

, , .

: «

». ,

« » -

« »

,

»,

,

,

.

,

,

. ,

,

.

 

 

165

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. .

 

 

 

 

,

.

 

 

 

,

, ,

 

 

 

 

 

 

 

 

 

(

 

III ) ,

 

 

 

 

,

»

 

 

-

» ,

 

 

 

 

.

 

 

 

 

 

 

 

 

 

,

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

.

 

.

 

 

 

 

« »

 

 

-

 

,

 

,

 

 

 

 

 

 

 

.

 

 

, -

 

 

 

,

 

,

 

.

« -

,

 

 

 

»

 

 

,

 

 

 

,

 

-

 

 

 

 

-

 

 

 

,

 

,

,

 

.

 

 

 

 

 

-

.

 

 

 

 

 

 

 

 

,

-

 

 

 

( ,

.

« -

 

 

 

 

 

, » -

 

 

),

 

 

.

 

 

 

 

 

-

. ,

 

,

-

 

 

 

 

 

. -

 

 

 

 

, -

 

 

 

-

,

 

, -

 

. -

 

 

 

 

,

 

 

 

.

 

 

 

 

,

 

 

 

, , ,

166

 

« -

,

» - -

.

. -

-

, ,

-

,

« -

, ( ) ,

», -

, -

 

,

.

 

– ,

 

-

 

. -

,

-

pH .

, -

,

, -

,

-

 

 

.

167

. .

SUGGESTED READINGS

1.Marino, Paul L. ICU Book, The, 3rd Edition Lippincott Williams & Wilkins

©2007

2.Michael W. King, Ph.D. Hemoglobin and Myoglobin. Medical Biochemistry

Terre Haute Center for Medical Education. 1997

3.Michael G. Levitzky, Ph.D Pulmonary Physiology 7th Edition by The McGrawHill Companies, Inc., 2007

4.West J. B. Respiratory physiology: the essentials, 8th edition Lippincott Williams & Wilkins ©2008

5.Brian K Genlbach, Gregory A Schmidt Treating acid-base abnormalities in the intensive care unit – the role of buffers BioMed Central Ltd, Critical Care 2004

6.Donall O’Croinin, Martina Ni Chonghaile, Brendan Higgins, John G Laffey Permissive hypercapnia Critical Care 2004, BioMed Central Ltd

7.Howard E Corey Fundamental principles of acid-base physiology Critical Care

2004, BioMed Central Ltd

8.Brandis Kerry Acid-base pHysiology www.qldanaesthesia.com, www.anaesthesiaMCQ.com

9.Arthur C. Guyton, M.D., John E. Hall, Ph.D. Textbook of Medical Physiology 11th ed. 2006, Elsevier Inc. Philadelphia

10.Pinsky Michael R., MD, Brochard L., MD, Mancebo J., MD Applied Physiology in Intensive Care Medicine, Springer-Verlag Berlin Heidelberg 2006

11.Irwin, Richard S.; Rippe, James M. Irwin and Rippe's Intensive Care Medicine, 6th Edition, Lippincott Williams & Wilkins Copyright ©2008

12.Brenner Matthew, MD Critical Care Medcine, 2007 Michael Krutzik, M.D, Guy Foster, MD Endocrinologic and Nephrologic Disorders

13.Albert Clark, Jason O’Neale Roach CRASH COURSE: metabolism and nutrition Elsevier Inc. Copyright © 2007

14.Koolman J., Roehm K. H. Color Atlas of Biochemistry 2nd edition Thieme Stuttgart-New York 2005

15.Phillips Lynn D. IV therapy notes F. A. Davis Company, Philadelphia, 2005

168

16.Michael J. Apostolakos, M.D. Peter J. Papadakos, M.D. Intensive Care Manual McGRAW-HILL, Medical publishing division, 2001

17.Mary J. Mycek, Ph.D., Richard A. Harvey, Pamela C. Champe Lippincott’s illustrated reviews: pharmacology Lippincott Williams & Wilkins Copyright

©2000

18.Hopkins B. Tracey, BSN, RN Lab Notes: Guide to Lab and Diagnostic Tests

F. A. Davis Company, Philadelphia, 2005

19.Lewis J Kaplan and Spiros Frangos. Clinical review: Acid–base abnormalities in the intensive care unit – part II, New Haven, Connecticut, 2004 BioMed Central Ltd

20.Mazzagatti F.A, Lebovits L.C., Schluger N.W Respiratory care pearls, Hanley & Belfus, Philadelphia ( . , ), 2002 p.221-235

21.Margretta R Seashore The Organic Acidemias: An Overview, GeneReview – Last Revision 2006

22.Charles P Venditti, MD, PhD Methylmalonic Acidemia Genetic Disease Research, National Human Genome Research Institute, National Institutes of Health, 2005.

23.Kevin A Strauss, MD, Erik G Puffenberger, PhD, Holmes Morton, MD Maple Syrup Urine Disease (MSUD) Clinic for Special Children, University of Washington, Seattle Jan 30, 2006.

24.Milford Fulop, MD; Meggan Mackay, MD Renal Tubular Acidosis, Sjögren Syndrome, and Bone Disease Arch Intern Med. 2004.

25.Mahendra Agraharkar, MD, MBBS, FACP, Mark Fahlen, MD, Kanwarpreet Baweja, MD Hyperchloremic Acidosis www.eMedicine.com, Jul 25, 2006

26. Michele Azer, MD, Heatherlee Bailey, MD Toxicity, Salicylate www.eMedicine.com, Nov 8, 2007

27.Kreplick Lance W, MD, MMM, FAAEM, FACEP, Toxycity, Salicylate, www.eMedicine.com, Jul 11, 2008

28.Ann G Egland, MD, Douglas R Landry, MD Toxicity, Alcohols www.eMedicine.com, January 4, 2007

169

. .

29.Christie P Thomas, MB, BS, Khaled Hamawi, MD Metabolic Acidosis www.eMedicine.com, Feb 1, 2007

30.Karen L Stavile, MD Metabolic Acidosis www.eMedicine.com September 22,

2005

31.Hipp Antonia, DO, Metabolic Acidosis, www.eMedicine.com, Sept 11, 2008

32.Andrade V. B., Flávio O. Ihara, Eduardo J. Troster Metabolic acidosis in childhood: why, when and how to treat J. Pediatr. (Rio J.) vol.83 no.2 suppl.0 Porto Alegre May 2007

33.Alper Brent A. Jr, MD, MPH, Uremia, www.eMedicine.com, Jun 6, 2008

34.Sameer Yaseen, MD, Christie Thomas, MD, FACP, FAHA, FASN Metabolic Alkalosis www.eMedicine.com, May 3, 2007

35.Huang H Lennox, MD, Alkalosis, Metabolic www.eMedicine.com, Aug 13,

2008

36.Frassetto Lynda A., MD, Bartter Syndrome, www.eMedicine.com, May 16,

2008

37.Devarajan Prasad, MD, Bartter Syndrome, www.eMedicine.com, Oct 1, 2008

38.Scofield R Hal, MD, Milk-alkali Syndrome, www.eMedicine.com, Jun 13, 2007

39.Gordon Michelle V, Hamblin P Shane, McMahon Lawrence P Life-threatening milk-alkali syndrome resulting from antacid ingestion during pregnancy eMJA 182 (7): 350-351, 2005

40.Ammonium chloride, reffered articles, University of Maryland Medical Center (UMMC) © 2008

41.Daniel C Keyes, MD, MPH Toxicity, Ethylene Glycol www.eMedicine.com, Dec 11, 2007

42.Osama Hamdy, MD, PhD Diabetic Ketoacidosis www.eMedicine.com, Sep 20,

2007

43.Donald W Rucker, MD, MBA, MS, Diabetic Ketoacidosis www.eMedicine.com Feb 12, 2008

44.David E. Trachtenbarg, MD, Diabetic Ketoacidosis, American Academy of Family Physicians Vol. 71/No. 9 May 1, 2005

170