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第四章 酸碱平衡和酸碱平衡紊乱 PowerPoint PPT Presentation


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[H + ]↑. 肾脏排H +.  回收 HCO - 3 (3-5日). H + +HCO - 3 →H 2 CO 3. (3-4h). 细胞内液. 细胞外液. ↓. 缓  冲. 缓  冲. H 2 O+CO 2. (即刻). (几分钟} .  肾的调节. 体液缓冲系统          肺的调节. 第四章 酸碱平衡和酸碱平衡紊乱. 第一节  酸碱物质的来源及稳态. 一、体液酸碱物质的来源(略). 二、酸碱平衡的调节. 当体内H + 负荷增加时是靠各种缓冲系统及肺肾 的调节作用来维持体液的 pH 相对稳定 。.

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第四章 酸碱平衡和酸碱平衡紊乱

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pH


NaHCO3H2CONa2HPO4NaH2PO4NaPrHPr

KHCO3H2CO3K2HPO4KH2PO4

KPrHPrKHbHHbKHbHHbO


HPO42

Buf

Pr

Hb

H2CO3CO2

S042HPO42

HbBuf


CSF

PaCO2

CO


HNH3HCO3

HCO

Na

NHHCO

1moL 1moLHCO3HN HCO3


Na

Na

H

ATP

Na K

ATP

K

H

H

Cl

HCO3

H

H

HCO3

H2CO3

H2CO3

Na

CA

H2CO3

CA

CA

CO2H2O

HCO3

CO2H2O

H2O CO2

4-1 H HCO3


HHPO4HPO


Na

Na

H

ATP

Na K

ATP

K

H

H

Cl

HCO3

H

H

HCO3

H2CO3

H2CO3

Na

CA

H2CO3

CA

CA

CO2H2O

HCO3

CO2H2O

H2O CO2

4-1 H HCO3



3NH4+

4-2

pH


NH3

Na

NH3

Na

H

ATP

Na K

ATP

K

H

H

NH4

Cl

NH4

H2CO3

H

HCO3

Na

H2CO3

CA

CO2H2O

HCO3

a-

4-2


= Pka +

pH = Pka +

24

24

20

7.40

6.1

pH 6.1

6.1

1

1.2

0.03 40

pHHCO3H2CO3

Henderson-Hassalbach)

Pka

mmolL

mm

0.03


20

=

pH 7.357.45

2

1

pH 7.35

pH 7.45

2

2


pH pHH+, pH = -

pH

pH pH

pH

pH


PaCO2 (partial pressure of carbon dioxide)

PaCO2CO2

4.39~6.25Kpa 5.32Kpa

PaCO2=PACO241

PaCO26.25Kpa CO2

PaCO239Kpa CO2

PaCO2


PaCO2

SBBBBE

[H2CO3]

AB

[HCO3]

4-1


SBStandardbicarbonate

SBo100pa

22~27mmol/L 24mmol/L

SB


ABAcutualBicarbonate

AB

AB

ABSBAB

ABSB

ABSB

ABSB

ABSB

ABSB


BBBufferBasc

BB

BB

4552mmol48mmol

BB

BB

BB

BB


BE (Base Excess)

BEpH7.40

mmolL

BE

BE

BE


CI

Na

140

104

HCO3

24

UA

Uc

AGAnionGap

1401042412mmol

1014mmol12mmol

  • mmol


20

pH 7.35

2

1

metabolic acidosis)

pH


3

1

2

6

4

1

2

5


AG = Na+ ( CI HCO3) = UAUc

N

N

1AG

2AGHCO3CI

HCO3


HPO42

H

HBuf

HBuf

Buf

Pr

K

K

Hb

(

1

1

H+ + HCO3 H2CO3 H2O + CO2

H+ + Buf HBuf

2


PaCO2

SB BBBE

[H2CO3]

AB

[HCO3]

ABSB BB BE PaCO2



A

-

NH3

-

-

GABA

GABA ATP

2


20

pH 7.35

1

2

respiratory acidosis)

H2CO3pH

CO2PaCO2


20

20

1

2

1

2


H

HPr

HPr

CA

CO2

H2O

H2CO3

HCO3

K

K

1


CA

CO2

CO2(CO2

H2CO3

H2O

Na+

HCO3

NaHCO3

H+HCO3

HHb

Hb K+

Cl

Cl

KHbO2

O2

O2

4-3

(2)


PaCO21.3Kpa

HCO30.71.0mmol/L, HCO3/ H2CO3

2

35PaCO2

1.3Kpa HCO33.54.0mmol/L,

HCO3/ H2CO3


PaCO2

SBBBBE

PaCO2

ABSBBBBE

[H2CO3]

AB

[HCO3]

3

1

CO2

2


CO2H2O

CA

H2CO3

HCO3

H

HCO3

H

HCI

CI

CI

H

H2CO3

H

H

HCO3

HCO3

metabolic alkalosis

HCO3pH

1H

1HCI


H

ATP

H

H

CI

HCO3

2

1

2

CuShing

2HCO3

1NaHCO3

2

3

3H+

4


1

HCO3

2

CuShing


PaCO2

SBBBBE

[H2CO3]

AB

[HCO3]

ABSBBBBE

PaCO2

1

2

3

4


A

-

NH3

-

-

GABA


1

GABA

2

3Ca2+

4


20

pH 7.45

2

1

respiratory alkalosis)

H2CO3pH

hystaria):


PaCO224pH

PaCO224pH


H2CO3

HBuf

Buf H

H HCO3

K

K

HPO42

Buf

Pr

H

Hb

LAC

1


Cl

Cl

HCO3

H+

HCO3

H2CO3

H2OCO2

CO2+H2O

H2CO3

HPr(HHb)

Pr (Hb) H+

H+HCO3

H2CO3

K+

K+

4-4


PaCO23Kpa HCO32mmol/L HCO3/ H2CO3

2

PaCO23KPa HCO35mmol/L HC03/ H2CO3


PaCO2

SBBBBE

PaCO2

ABSBBBBE

[H2CO3]

AB

[HCO3]

3



1

2


4-1

pH

HCO3PaCO2


PaCO2

HCO3

PaCO2 HCO3


4-3

[HCO3]

PaCO2

PaCO2=1.5[HCO3]82

PaCO2 =1.2[HCO3] 2

[HCO3]

PaCO2

PaCO2 =0.9[HCO3] 5

PaCO2

[HCO3]

[HCO3] =0.1PaCO2 1.5

PaCO2

[HCO3]

[HCO3] =0.4PaCO2 3

PaCO2

[HCO3]

[HCO3] =0.2PaCO2 2.5

PaCO2

[HCO3]

[HCO3] =0.5PaCO2 2.5


1PaCO2 mmHg Kpa mmHg1Kpa=5 mmHg

PaCO232Kpa 40mmHg

2[HCO3][ HCO3][HCO3]24mmoI/L

3


24 oI/L

40


pHPaCO2[HCO3-]

AG16mmoI/LAG


pH25 PaCO2

96kpa HCO316 mmoI/L Na141 mmoI/LCI

105mmoI/L

AG

pH PaCO2

[HCO3]

1

1PaCO2=5[HCO3] 82

2

PaCO2=51682=322mmHg

3


PaCO230mmHg

4AG

AG= NaCl HCO3=14110516=20mmol/L

AG16mmol/L

5 AG

12PaCO2=2[HCO3] 2

2

PaCO2=224162=9.6 2mmHg

3 PaCO2=409.6=30.4 2mmHg

430mmHg AG

AG


1 2

3 4AG

5 6AG

7 8

1AG

2


3

4

5

6

7

8


9

10 pHPaCO2 HCO3


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