碱剩余判断代谢性酸碱平衡紊乱的研究进展
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摘要
<正>人体内组织细胞必须处于酸碱度适宜的体液环境中,才能进行正常的代谢活动。细胞外液的酸碱度用pH表示,正常范围为7.35～7.45,平均为7.40±0.05。机体在代谢过程中生成酸性或碱性物质,也会从外界摄取酸性或碱性食物;体液pH稳定在正常范围,是由于机体对酸碱负荷具有强大的缓冲能力和有效的调节功能,通过缓冲系统以及肺、肾的调节作用,这种生理情况下维持体液酸碱度的相对稳定性称为酸碱平衡。但有许多原因可
The acid-base disorder is divided into respiratory and metabolic disorders.Pco2 is the primary index of acid-base abnormalities caused by respiratory factors.However,the metabolic factors need more complex analytical methods.BE is a simple but effective method for the clinical analysis of non respiratory components of acid-base disorder;the base excess can be used to diagnose metabolic acidosis and to guide liquid resuscitation,but the single index is not sufficient to determine the completeness of the resuscitation.The base excess method also has important guiding significance in predicting the severity and prognosis of the critically ill patients,and it will improve the effectiveness of the base excess method in the assessment of the acid-base status when combined with the anion gap.
The acid-base disorder is divided into respiratory and metabolic disorders.Pco2 is the primary index of acid-base abnormalities caused by respiratory factors.However,the metabolic factors need more complex analytical methods.BE is a simple but effective method for the clinical analysis of non respiratory components of acid-base disorder;the base excess can be used to diagnose metabolic acidosis and to guide liquid resuscitation,but the single index is not sufficient to determine the completeness of the resuscitation.The base excess method also has important guiding significance in predicting the severity and prognosis of the critically ill patients,and it will improve the effectiveness of the base excess method in the assessment of the acid-base status when combined with the anion gap.
引文
[1] Hamilton PK,Morgan NA,Connolly GM,et al.Understanding Acid-Base Disorders[J].Ulster Med J,2017,86(3):161-166.
[2] Gomez H,Kellum J A.Understanding Acid Base Disorders[J].Crit Care Clin,2015,31(4):849-860.
[3] Ibrahim I,Chor WP,Chue KM,et al.Is arterial base deficit still a useful prognostic marker in trauma?A systematic review[J].Am J Emerg Med,2016,34(3):626-635.
[4] Siggaard-Andersen O,Fogh-Andersen N.Base excess or buffer base(strong ion difference)as measure of a non-respiratory acid-base disturbance[J].Acta Anaesthesiol Scand Suppl,1995,107:123-128.
[5] Severinghaus J W.Siggaard-Andersen and the“Great Trans-Atlantic Acid-Base Debate”[J].Scand J Clin Lab Invest Suppl,1993,214:99-104.
[6] Schwartz WB,Relman AS.A critique of the parameters used in the evaluation of acid-base disorders.“Whole-blood buffer base”and “standard bicarbonate”compared with blood pH and plasma bicarbonate concentration[J].N Engl J Med,1963,268:1382-1388.
[7] Juern J,Khatri V,Weigelt J.Base excess:a review[J].J Trauma Acute Care Surg,2012,73(1):27-32.
[8]Wooten E W.The standard strong ion difference,standard total titratable base,and their relationship to the Boston compensation rules and the Van Slyke equation for extracellular fluid[J].J Clin Monit Comput,2010,24(3):177-188.
[9] Morgan T J.Partitioning standard base excess:a new approach[J].J Clin Monit Comput,2011,25(6):349-352.
[10]Gilfix BM,Bique M,Magder S.A physical chemical approach to the analysis of acid-base balance in the clinical setting[J].J Crit Care,1993,8(4):187-197.
[11]Gale SC,Kocik JF,Creath R,et al.A comparison of initial lactate and initial base deficit as predictors of mortality after severe blunt trauma[J].J Surg Res,2016,205(2):446-455.
[12]Santi M,Mcanulty G,Grounds M.Base excess and lactate as prognostic indicators for patients admitted to intensive care-15years later[J].Intensive Care Med Exp,2015,3(S1):1-2.
[13]Matou2ovic K,Havlín J,Schück O.[Clinical evaluation of acid-base status:Henderson-Hasselbalch,or Stewart-Fencl approach?][J].Casopis Lekaru Ceskych,2016,155(7):365.
[14]Kofstad J.Base excess:a historical review-has the calculation of base excess been more standardised the last 20years?[J].Clin Chim Acta,2001,307(1-2):193-195.
[15]Dukic L,Kopcinovic LM,Dorotic A,et al.Blood gas testing and related measurements:National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine[J].Biochem Med(Zagreb),2016,26(3):318-336.
[16]Berend K.Diagnostic Use of Base Excess in Acid-Base Disorders[J].N Engl J Med,2018,378(15):1419-1428.
[17] Knutzen L,Svirko E,Impey L.The significance of base deficit in acidemic term neonates[J].Am J Obstet Gynecol,2015,213(3):371-373.
[18]Dunham MP,Sartorius B,Laing GL,et al.A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting[J].Injury,2017,48(9):1972-1977.
[19]Mutschler M,Nienaber U,Brockamp T,et al.Renaissance of base deficit for the initial assessment of trauma patients:a base deficit-based classification for hypovolemic shock developed on data from 16,305patients derived from the TraumaRegister DGU(R)[J].Crit Care,2013,17(2):R42.
[20]Connelly CR,Schreiber MA.Endpoints in resuscitation[J].Curr Opin Crit Care,2015,21(6):512-519.
[21]Callaway DW,Shapiro NI,Donnino MW,et al.Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients[J].J Trauma,2009,66(4):1040-1044.
[22]Eberhard LW,Morabito DJ,Matthay MA,et al.Initial severity of metabolic acidosis predicts the development of acute lung injury in severely traumatized patients[J].Crit Care Med,2000,28(1):125-131.
[23]Penasco Y,Gonzalez-Castro A,Rodriguez-Borregan J C,et al.Base excess,a useful marker in the prognosis of chest trauma in the geriatric population[J].Rev Esp Anestesiol Reanim,2017,64(5):250-256.
[24]Soderlund T,Ikonen A,Pyhalto T,et al.Factors associated with in-hospital outcomes in 594consecutive patients suffering from severe blunt chest trauma[J].Scand J Surg,2015,104(2):115-120.
[25]Umemura T,Nakamura Y,Nishida T,et al.Fibrinogen and base excess levels as predictive markers of the need for massive blood transfusion after blunt trauma[J].Surgery Today,2016,46(7):774-779.
[26]Davis JW,Kaups KL,Parks SN.Base deficit is superior to pH in evaluating clearance of acidosis after traumatic shock[J].J Trauma,1998,44(1):114-118.
[27]Momiyama Y,Yamada W,Miyata K,et al.Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest[J].Acute Med Surg,2017,4(1):25.
[28]Jouffroy R,Lamhaut L,Guyard A,et al.Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome[J].Resuscitation,2014,85(12):1764-1768.
[29]Kohen CJ,Hopper K,Kass PH,et al.Retrospective evaluation of the prognostic utility of plasma lactate concentration,base deficit,pH,and anion gap in canine and feline emergency patients[J].J Vet Emerg Crit Care(San Antonio),2018,28(1):54-61.
[30]Ubeda A,Alonso L,Esquinas AM.Base excess,a useful marker in the prognosis of chest trauma in the geriatric population[J].Rev Esp Anestesiol Reanim,2018,65(1):64-65.
[2] Gomez H,Kellum J A.Understanding Acid Base Disorders[J].Crit Care Clin,2015,31(4):849-860.
[3] Ibrahim I,Chor WP,Chue KM,et al.Is arterial base deficit still a useful prognostic marker in trauma?A systematic review[J].Am J Emerg Med,2016,34(3):626-635.
[4] Siggaard-Andersen O,Fogh-Andersen N.Base excess or buffer base(strong ion difference)as measure of a non-respiratory acid-base disturbance[J].Acta Anaesthesiol Scand Suppl,1995,107:123-128.
[5] Severinghaus J W.Siggaard-Andersen and the“Great Trans-Atlantic Acid-Base Debate”[J].Scand J Clin Lab Invest Suppl,1993,214:99-104.
[6] Schwartz WB,Relman AS.A critique of the parameters used in the evaluation of acid-base disorders.“Whole-blood buffer base”and “standard bicarbonate”compared with blood pH and plasma bicarbonate concentration[J].N Engl J Med,1963,268:1382-1388.
[7] Juern J,Khatri V,Weigelt J.Base excess:a review[J].J Trauma Acute Care Surg,2012,73(1):27-32.
[8]Wooten E W.The standard strong ion difference,standard total titratable base,and their relationship to the Boston compensation rules and the Van Slyke equation for extracellular fluid[J].J Clin Monit Comput,2010,24(3):177-188.
[9] Morgan T J.Partitioning standard base excess:a new approach[J].J Clin Monit Comput,2011,25(6):349-352.
[10]Gilfix BM,Bique M,Magder S.A physical chemical approach to the analysis of acid-base balance in the clinical setting[J].J Crit Care,1993,8(4):187-197.
[11]Gale SC,Kocik JF,Creath R,et al.A comparison of initial lactate and initial base deficit as predictors of mortality after severe blunt trauma[J].J Surg Res,2016,205(2):446-455.
[12]Santi M,Mcanulty G,Grounds M.Base excess and lactate as prognostic indicators for patients admitted to intensive care-15years later[J].Intensive Care Med Exp,2015,3(S1):1-2.
[13]Matou2ovic K,Havlín J,Schück O.[Clinical evaluation of acid-base status:Henderson-Hasselbalch,or Stewart-Fencl approach?][J].Casopis Lekaru Ceskych,2016,155(7):365.
[14]Kofstad J.Base excess:a historical review-has the calculation of base excess been more standardised the last 20years?[J].Clin Chim Acta,2001,307(1-2):193-195.
[15]Dukic L,Kopcinovic LM,Dorotic A,et al.Blood gas testing and related measurements:National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine[J].Biochem Med(Zagreb),2016,26(3):318-336.
[16]Berend K.Diagnostic Use of Base Excess in Acid-Base Disorders[J].N Engl J Med,2018,378(15):1419-1428.
[17] Knutzen L,Svirko E,Impey L.The significance of base deficit in acidemic term neonates[J].Am J Obstet Gynecol,2015,213(3):371-373.
[18]Dunham MP,Sartorius B,Laing GL,et al.A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting[J].Injury,2017,48(9):1972-1977.
[19]Mutschler M,Nienaber U,Brockamp T,et al.Renaissance of base deficit for the initial assessment of trauma patients:a base deficit-based classification for hypovolemic shock developed on data from 16,305patients derived from the TraumaRegister DGU(R)[J].Crit Care,2013,17(2):R42.
[20]Connelly CR,Schreiber MA.Endpoints in resuscitation[J].Curr Opin Crit Care,2015,21(6):512-519.
[21]Callaway DW,Shapiro NI,Donnino MW,et al.Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients[J].J Trauma,2009,66(4):1040-1044.
[22]Eberhard LW,Morabito DJ,Matthay MA,et al.Initial severity of metabolic acidosis predicts the development of acute lung injury in severely traumatized patients[J].Crit Care Med,2000,28(1):125-131.
[23]Penasco Y,Gonzalez-Castro A,Rodriguez-Borregan J C,et al.Base excess,a useful marker in the prognosis of chest trauma in the geriatric population[J].Rev Esp Anestesiol Reanim,2017,64(5):250-256.
[24]Soderlund T,Ikonen A,Pyhalto T,et al.Factors associated with in-hospital outcomes in 594consecutive patients suffering from severe blunt chest trauma[J].Scand J Surg,2015,104(2):115-120.
[25]Umemura T,Nakamura Y,Nishida T,et al.Fibrinogen and base excess levels as predictive markers of the need for massive blood transfusion after blunt trauma[J].Surgery Today,2016,46(7):774-779.
[26]Davis JW,Kaups KL,Parks SN.Base deficit is superior to pH in evaluating clearance of acidosis after traumatic shock[J].J Trauma,1998,44(1):114-118.
[27]Momiyama Y,Yamada W,Miyata K,et al.Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest[J].Acute Med Surg,2017,4(1):25.
[28]Jouffroy R,Lamhaut L,Guyard A,et al.Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome[J].Resuscitation,2014,85(12):1764-1768.
[29]Kohen CJ,Hopper K,Kass PH,et al.Retrospective evaluation of the prognostic utility of plasma lactate concentration,base deficit,pH,and anion gap in canine and feline emergency patients[J].J Vet Emerg Crit Care(San Antonio),2018,28(1):54-61.
[30]Ubeda A,Alonso L,Esquinas AM.Base excess,a useful marker in the prognosis of chest trauma in the geriatric population[J].Rev Esp Anestesiol Reanim,2018,65(1):64-65.