2

.
, .
,

.
.


. ,
(eclass).

2.1
2.1.1 ;

. ,
.
.
.
.

2.1.2
. ,

.

.


. :
( Allen),
,
, .

(.. ).

.
.
: , , ,
, . .
.
( ).

23


Allen.
.
2.1 20 .
.
.
45 2.1.
.

2.1 .

,
.
. 2.2.
,
.
3 ml .
.
1ml 1% .
,

.

24

 2.2 . : http://www.ganfyd.org/index.php?title=Arterial_blood_gas.

,
.
.
.
.
,
.
,
, ,
.
, .

2.1.3 ;
1.
2.
3.
4.
5.
6.

[ + ].
2 , 2 .
2 , 2 .
, 3 .
, (Base Excess, : ).
, 2 .

2.3 2.4 .
.

25

 2.3 .

26

 2.4 .
.

2.1.4
;
: 7.35 7.45

27

2 : 35 45 mmHg
2 : 80 100 mmHg
3 : 22 26 mmol/L
: -2 - +2
2 : >95%

[1,2].
2
. : 2 =
104,2 [ () x 0.27].

2.1.5
;

+ <7.35.
+ >7.45.

.
, , .
.
. , ,
.

2.1.6 pH ;

+
[1, 2].

2.1.7 pH ;
.
, ( ),
. .
A Henderson-Hasselbach ( )
pH 3 2 :
[3 ]
= + log10 (
)
[2 ]
2
3
.

2.1.8 ;
.

28

 2.5 . = + 10 (

3
2

).

, 2.5,
2 . , 3 + ,
,
3 [3, 4].

2.1.9 ;
2.1 [3, 4].

,
,

,
( )

,
, , ,
,
.
, ,
,
.

, ,
, , .

,
, ,

, ,

2.1 .

2.2
2.2.1
;
1. ,
:

()
2. .

2.2.2 ;
.
, (shunt), /
.

29

 .
, ,
(Alveolar arterial 2 partial pressure difference, A-a 2 , mmHg).
, :
(2 ).
(2 ).
(2 ).
(2 ).
,
(2 ) (2 ).
2 = 2
:
2
2 = 2

R = 0.8
2 = 2 = (762 48) 2 = 714 2
(762 = Patm, , 48 =
37C )
2 2
=
= 2 1.25

0.80
2 2 = A-a 2
A-a 2 15 mmHg
A-a 2 > 15 mmHg ( ).

, .

2.2.3 ();
( )
(2 > 45). ,
, , , ,
. 2 (..
) ,
.
.
,
.
2
2 =

= +
:
2 = 2
=
=
=
( ml/min)
2 ( ).

2.2.4 1
2.2

30

A-a


(..
)

/ (..
)
--
(.. )
(..
)

2.2
A-a


(..
)

/ (..
)
--
(.. )
(..
)

X
X

X
X

2.3 1.

2.2.5 ;
:
.
.
( ).
( ).
( ).

2.2.6
;
1:
:
< 7.40 =
> 7.40 =
2:
2 3
A 2 = .
A 2 = .
3 = .
3 = .
, ;
3:

31

 ;
;
, ( );
4:
/ ( );

2.2.7 ;
2.4 [5].

HCO3-

HCO3-

CO2

CO2

CO2

CO2

PaCO2= (1.5 x [HCO3-] ) +

82
PaCO2=(0.7 x [HCO3-]) +
21 1.5
HCO3= 24 + (PaCO2
40)/10
HCO3= 24 + (PaCO2
40)/3
HCO3= 24 - (40
PaCO2)/5
HCO3= 24 - (40
PaCO2)/2.5

2.4

:
Kellum J.A. Determinants of blood pH in health and disease. Crit.Care 2000; 4(1): 6-14 PMID
11094491.

2.2.8 ;
Stewart
. : Sirker A. A., Rhodes A.,
Grounds R. M., Bennett E. D. Acid-base physiology: the traditional and the modern approaches.
Anaesthesia 2002; 57(4); 348356. PMID 11939993

2.2.9 2
.
;
7.50
2 30 mmHg
2 50 mmHg
2 21% = 0.21
1.
2.
3.
4.
2
2 = 2

= (762 48) 2 2 1.25

= (762 48) 0.21 30 1.25

32

= 113
A-a 2 = 113 50 = 63

:
2 .
.
.
.
(2, 3).

2.2.10 3
.
;
7.20
2 80 mmHg
2 42 mmHg
2 21% = 0.21
1.
2.
3.
4.
2
2 = 2

= (762 48) 2 2 1.25

= (762 48) 0.21 80 1.25
= 50
A-a 2 = 50 42 = 8
:
2 .
.
.
.

(1, 2).

2.2.11 4
.
;
7.50
2 30 mmHg
2 90 mmHg
2 60% = 0.60
1. XA
2.
3.
4.
2
2 = 2

= (762 48) 2 2 1.25

= (762 48) 0.60 30 1.25
= 390

33

A-a 2 = 390 90 = 300

:
2 .
.
.
(2).

2.3 : pH < 7.4, HCO3 < 24 mEq/L

2.3.1 1
, ,
.
:
7.15
2 92 mmHg
2 22 mmHg
3 9 mmol/L
-30 mmol/L
=140
=104
180/110 mmHg
130/min
40 /min
:
< 7.4

[3 ] < 24 mEq/L
: M .
.
2 .
2 = 1.5 [3 ] + 8 2 ,
, 2 21.5 2, .
: ,
6-12 .
2.6
.

34

 2.6 .

2.3.2 ;
(. .) (
) 3 ( ).
:
+ + = 3 + +
+ [3 + ] = -
2.7.

35

 2.7 .

. . :



, , , ,
N ,
. . :
HCO3- (.. )

2.3.3 2
.
;
XA= + [3 + ] = -

36

XA=140-(9+104)= 27.
.
.
, .

2.3.4

.

, , ,
, .
,
..
.

.
, ,
.
, , , ,
, , .

.
, , ,
. ,
, , , .
.
.
,
, , , ,
, , ,
.
:
o
o
o
o
o ( )
o
o
0.9
NaCl < 300 mg/dl.
5% .
2.5.

1 L 0.9 N/S 30 :
1 L 0.9 N/S + 1 :
1 L 0.9 N/S + 2 :
1 L 0.9 N/S + 4 .
2.5 .

,
.
2.6.

37

+ mmol/L
<3
<4
<5

+ mmol/L
40
30
20

2.6 .

.
.
.

. 2.7
.
mg/dl ( )
<69
70-129
130-199
200-279
280-349
350-400
>400

(U/h)
0.5
1
2
3
4
5
6

2.7 .

A pH.
.
, , ,
.

2.3.5 ,
;
H , (>10 mOsm/L),
.
= -
= 2[Na]+[] mmol/L+[] mmol/L

38

2.3.6 ;

2.8 .

,
.

39

2.3.7
;

2.9 .

40

 ,
HCO3 [ ] .

E

IV

2.8 .

, . 2.8
.

2.3.8 ;

.
:
Forsythe S. M., Schmidt G. A. Sodium bicarbonate for the treatment of lactic acidosis. Chest. 2000
Jan;117(1):260-7. PMID10631227

2.4 HCO3 >24mEq/L pH> 7.4

2.4.1 1
74 ,
, . 40% :
7.52 - 130/90 mmHg
2 55 mmHg - 120/min
2 92 mmHg - 25/min
3 42 mmol/L - BE 17 mmol/L
:
3 > 24 ( 3 )

> 7.40
: M

2
2 = 0.7 [3 ] + 21 1.5
= 0.7 42 + 21 1.5
= 50.4 1.5
2.10.

41

 2.10 .

2 .
;
2
, .
,
, .

2.4.2 ;

(contraction alkalosis)
( )
+

42

2.4.3 ;

2.11 .

2.5 : pH<7.4 , PaCO2> 40mmHg

2.5.1 1
, ,
20
. ,
, , (stridor).
10 L , :
7.10 - 150/110 mmHg
2 60 mmHg - 150/min
2 125 mmHg - 45/min
3 18 mmol/L
43

 -15 mmol/L
:
2 pH
< 7.40
2 > 40 mmHg
2 ().
: .
3 . .

.
2.12
.

2.12 .

2.12 3
;

44

 2.13

2.13 3 25-28 mEq/L.

:
2 40
[3 ] = 24 +
= 24 + 2 = 26(/)
10
;
.
: ,
, .

2.5.2 ;
, o (..
/ ), (..
, ).

45

2.5.3 ;

2.14 .

2.6 : pH>7.40, PaCO2<40 mmHg

2.6.1 ;
A : > 7.40 2 < 40.
H 2 .
:
1.
2.
3. (, , , , ,
, )
4. .
H .

2.6.2 1
A 60 . :
7.50
2 30 mmHg
2 50 mmHg
2 21% = 0.21
: .
.

46

2.6.3 ;

2.15 .

47


1. . (2009). . : . . . ISBN 978-960-399-9201.
2. . . .
3. Gennari F. J., Adrogue H. J., Galla J. H., Madias N. E. (2005). AcidBase Disorders and Their
Treatment. Boca Raton, FL. Taylor & Francis Group. ISBN-13: 978-0-8247-5915-5
4. Halperin M. L., Goldstein M. B. (2010) Fluid, Electrolyte and Acid Base Physiology. A Problem
Based Approach. 2nd Edition. Philadelphia PA. W.B. Saunders. ISBN-13: 978-1416024422
5. Burton D Rose. (2001). Clinical Physiology of Acid-Base and Electrolyte disorders. 5th Edition. New
York NY. Mc Graw Hill. ISBN 0-07134682-1.
6. . (2013). . .
.

1
. T ;
7.1
2 40
3 12
X.A.=20

M .

2

;

3
.
1
2.
1
1.
2.
3.

4. gram-
5. ,
6.
7.

48

1.
2.
3.
4.
5.
6.
7.

,

A ,
,
,

1
2
3
4
5
6
7

5
1
2
6
7
3
4

2.9

4
;
1. = 7.57, 2 = 41, 3 = 40
2. = 7.28, 2 = 40, 3 = 18
3. = 7.27, 2 = 28, 3 = 13
4. = 7.20, 2 = 24, 3 = 10

1.
2.
3.
4.

= 7.57, 2
= 7.28, 2
= 7.27, 2
= 7.20, 2

= 41, 3
= 40, 3
= 28, 3
= 24, 3

= 40
= 18
= 13
= 10

5
50 AIDS
. : = 7.06, 2 = 28, 3 = 8, 2 = 84.
;
1. .
2. .
3. .
4. , .

3 .
, 2
.

6
50
: = 7.35, 2 = 64, 3 = 33, 2 = 70.
;

49


O
A-a 2 = [(762-48) x 0.21- 64 x 1.25]-70=0
.
< 7.40
2 >40 mmHg
.
H 3 = 33 .

40

2
3 = 24 +
= 32 3 .
3
.

7
:
.

130
136
130
140
142

A
B

95
94
85
100
100

10
24
29
20
32

7.34
7.39
7.5
7.27
7.41

19
39
36
44
52

2.10

1.
2.
3.
4.
5.

..

1.
2.
3.
4.
5.

8
50 ,
12 . .
: = 7.28, 2 = 66, 3 = 30, 2 = 38, = 140, =
4.1, = 98.
.

2 ,
. .

50

 .
( ) ( )
.
.
2 40
,
+ 24 = 26.6/.
10
.

9
M 28 .
. . : = 7.24, 2 =
92, 2 = 28, 3 = 12, Ur=17mg/dl , Cr=1.3, Na=139, K=1.7, Cl=115, pH = 6.5, ..
=1.020. .
;

7.28 .
3 = 12 / (<24mEq/L) ( 2 ).
,
.
.
..= + ([3 ] + [ ])= 139 - (12+115) = 12
, .

.
IV .
:
;
O . ,
.

10
75 .

Ringers Lactate KCl 15 meq/L.
: = 7.66, 2 = 100, 2 = 32, 3 = 35/, + = 3.5, + = 133.
;
;

3 ,
. 2 ,
( ,
2 ).
, . .
.
1. N R/L 0.9 .
2. .

51

 11
65
.
. :
= 6.9, 2 = 450, 2 = 100%, 2 = 22, 3 = 4.2/, + = 4.5, + = 143,

= 94.
;

H 3 .

.
2 ,
2 = 1.5 [3 ] + 8 2. 2 14.3 2.
, ,
.
, .. .. 43.
.
. .
..
.. 3 .
3 24. ( 3 ).
3 24-4.5=19.5 mEq/L. .. 3 .
.
,
.

52