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第八章 酸碱平衡与肾脏功能 PowerPoint PPT Presentation


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第八章 酸碱平衡与肾脏功能. 本章提要:. 机体需要保持体液酸碱度的相对恒定,否则会导致组织代谢的紊乱,进而影响各种生理功能。机体通过血液缓冲系统、肺、肾,调节体内酸性和碱性物质的含量及比例,是维持体液 pH 恒定和调节酸碱的主要途径。本章主要介绍酸碱平衡的基本概念、体内酸碱物质的来源、酸碱平衡的调节、运动时机体酸碱平衡的变化及其调节途径和方式。.

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第八章 酸碱平衡与肾脏功能

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5075173

pH

1234


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:pH

pH

1

2

  • pH7.35-7.457.4pH6.9-7.8


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pH

  • ()


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NaHCO3/H2CO3/ Na2HPO4/NaH2PO4

KHCO3/H2CO3/

/

K2HPO4/KH2PO4

CO2H2CO3NaHCO3/H2CO3CO22


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  • a.

  • b.

  • c.


  • 5075173

    excretion

    • CO2

    • ()


    5075173


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    1


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    ,24180


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    EEP

    =-+

    =6.0 (2.67+1.33)

    =2.0kPa(15mmHg)

    0

    =6.0 (4.67+1.33)

    = 0kPa(0mmHg)

    0


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    25


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    1.5m2

    600-700ml/min


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    2


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    (

    )


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    24180L1.5-2L,99%

    g/L


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    60%-70%

    10%

    10%

    20%

    8.88-9.99mmol/L160-180mg/dl

    65%-70%


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    3


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    1. H+Na+


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    H+

    NH4+

    H+

    NH3 +

    H+

    H+:

    Na+-H+

    H+

    H+:

    H+HCO3-Na+

    H+

    =H+(H+HCO3-)

    H+K+()

    H+:pH4.5,H+


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    2NH3

    NH3:

    NH3H+NH3H+-Na+,

    NH3pHpHNH3

    NH3;,


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    NH3

    :

    NH3()

    NH3H+

    NH4+Cl-NH4Cl


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    3

    Na2HPO4/NaH2PO441H+pHH+Na+Na2HPO4NaH2PO4Na+HCO3-NaHCO3


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    H2O+CO2

    HPO42-

    H2CO3

    HCO3- + H+

    H+ +HPO42-

    Na+

    Na+

    ATPase

    H2PO4-


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    4

    NaHCO32227mmol/L1321mmol/LNaHCO328mmol/LNaHCO3 NaHCO3

    PCO2H+1


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    2000ml/d350-400ml/d

    1

    ADH

    +


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    2-

    ADH

    ADH


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    1

    pH

    2


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    1

    2

    3

    4P217


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    H2CO3

    NaHCO3

    pH7.06.3-6.4pH7.47.0pH


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    pH

    pH7.337.45 pHpHpHpH

    CO2CO2

    CO2total CO2T-CO2 2328mmol/L

    CO2CO2CPCO2100ml CO240mmHgCO2ml%


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    CO2HCO3-NaHCO3/HCO3-

    CO2CPCO2CP

    CO2

    CO24.76.44.36.0

    Pco2 CO2Pco26.4,CO2Pco24.3Pco2


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    ABHCO3-

    2126mmol/L

    SB38Po240mmHgHCO3-

    SBABSBSB

    BB4552mmol/L


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    pH

    pHpH0.40.6pH

    ATP

    ATP ADP+Pi+nH++

    H+pHpH


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    H+


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    ()6-1-

    6-1-H+

    + Pi 6- + nH+

    pKa=6.8

    pKa=6.1

    + pi 1- + nH+

    pKa=6.8

    pKa=6.44

    H+ H+4%pH


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    95%pKa499%H+

    CHOH6 2CH3CHOHCOO- + 2H+

    C6H10O5 2CH3CHOHCOO- + 2H+


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    1.2mmol/kg40019.72mmol/kg,pH6.6312.3mmol/LpH7.10


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    400pH


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    60%H+

    H+:


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    1

    CP + ADP + nH+ ATP + C

    pHpH7.0CP0.38H+pH6.40.7H+

    2

    ATP + nH+ IMP + 2Pi + NH4+

    1IMP0.41H+IMPH+


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    3

    H+

    AA + H++ O2 CO2 + H2O + NH4+

    AA

    H+3.1mmol/L

    61%39%


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    H+HCO3-

    NaHCO3


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