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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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4345702

pH


4345702

NaHCO3H2CONa2HPO4NaH2PO4NaPrHPr

KHCO3H2CO3K2HPO4KH2PO4

KPrHPrKHbHHbKHbHHbO


4345702

HPO42

Buf

Pr

Hb

H2CO3CO2

S042HPO42

HbBuf


4345702

CSF

PaCO2

CO


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HNH3HCO3

HCO

Na

NHHCO

1moL 1moLHCO3HN HCO3


4345702

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


4345702

HHPO4HPO


4345702

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


4345702


3 nh 4

3NH4+

4-2

pH


4345702

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


4345702

= 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


4345702

20

=

pH 7.357.45

2

1

pH 7.35

pH 7.45

2

2


4345702

pH pHH+, pH = -

pH

pH pH

pH

pH


Paco 2 partial pressure of carbon dioxide

PaCO2 (partial pressure of carbon dioxide)

PaCO2CO2

4.39~6.25Kpa 5.32Kpa

PaCO2=PACO241

PaCO26.25Kpa CO2

PaCO239Kpa CO2

PaCO2


4345702

PaCO2

SBBBBE

[H2CO3]

AB

[HCO3]

4-1


Sb standard bicarbonate

SBStandardbicarbonate

SBo100pa

22~27mmol/L 24mmol/L

SB


Ab acutual bicarbonate

ABAcutualBicarbonate

AB

AB

ABSBAB

ABSB

ABSB

ABSB

ABSB

ABSB


Bb buffer basc

BBBufferBasc

BB

BB

4552mmol48mmol

BB

BB

BB

BB


Be base excess

BE (Base Excess)

BEpH7.40

mmolL

BE

BE

BE


4345702

CI

Na

140

104

HCO3

24

UA

Uc

AGAnionGap

1401042412mmol

1014mmol12mmol

  • mmol


4345702

20

pH 7.35

2

1

metabolic acidosis)

pH


4345702

3

1

2

6

4

1

2

5


4345702

AG = Na+ ( CI HCO3) = UAUc

N

N

1AG

2AGHCO3CI

HCO3


4345702

HPO42

H

HBuf

HBuf

Buf

Pr

K

K

Hb

(

1

1

H+ + HCO3 H2CO3 H2O + CO2

H+ + Buf HBuf

2


4345702

PaCO2

SB BBBE

[H2CO3]

AB

[HCO3]

ABSB BB BE PaCO2


4345702


4345702

A

-

NH3

-

-

GABA

GABA ATP

2


Respiratory acidosis

20

pH 7.35

1

2

respiratory acidosis)

H2CO3pH

CO2PaCO2


4345702

20

20

1

2

1

2


4345702

H

HPr

HPr

CA

CO2

H2O

H2CO3

HCO3

K

K

1


4345702

CA

CO2

CO2(CO2

H2CO3

H2O

Na+

HCO3

NaHCO3

H+HCO3

HHb

Hb K+

Cl

Cl

KHbO2

O2

O2

4-3

(2)


4345702

PaCO21.3Kpa

HCO30.71.0mmol/L, HCO3/ H2CO3

2

35PaCO2

1.3Kpa HCO33.54.0mmol/L,

HCO3/ H2CO3


4345702

PaCO2

SBBBBE

PaCO2

ABSBBBBE

[H2CO3]

AB

[HCO3]

3

1

CO2

2


4345702

CO2H2O

CA

H2CO3

HCO3

H

HCO3

H

HCI

CI

CI

H

H2CO3

H

H

HCO3

HCO3

metabolic alkalosis

HCO3pH

1H

1HCI


4345702

H

ATP

H

H

CI

HCO3

2

1

2

CuShing

2HCO3

1NaHCO3

2

3

3H+

4


4345702

1

HCO3

2

CuShing


4345702

PaCO2

SBBBBE

[H2CO3]

AB

[HCO3]

ABSBBBBE

PaCO2

1

2

3

4


4345702

A

-

NH3

-

-

GABA


4345702

1

GABA

2

3Ca2+

4


Respiratory alkalosis

20

pH 7.45

2

1

respiratory alkalosis)

H2CO3pH

hystaria):


4345702

PaCO224pH

PaCO224pH


4345702

H2CO3

HBuf

Buf H

H HCO3

K

K

HPO42

Buf

Pr

H

Hb

LAC

1


4345702

Cl

Cl

HCO3

H+

HCO3

H2CO3

H2OCO2

CO2+H2O

H2CO3

HPr(HHb)

Pr (Hb) H+

H+HCO3

H2CO3

K+

K+

4-4


4345702

PaCO23Kpa HCO32mmol/L HCO3/ H2CO3

2

PaCO23KPa HCO35mmol/L HC03/ H2CO3


4345702

PaCO2

SBBBBE

PaCO2

ABSBBBBE

[H2CO3]

AB

[HCO3]

3


4345702


4345702

1

2


4345702

4-1

pH

HCO3PaCO2


4345702

PaCO2

HCO3

PaCO2 HCO3


4345702

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


4345702

1PaCO2 mmHg Kpa mmHg1Kpa=5 mmHg

PaCO232Kpa 40mmHg

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

3


4345702

24 oI/L

40


4345702

pHPaCO2[HCO3-]

AG16mmoI/LAG


4345702

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


4345702

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


4345702

1 2

3 4AG

5 6AG

7 8

1AG

2


4345702

3

4

5

6

7

8


4345702

9

10 pHPaCO2 HCO3


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