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最近我们核查了两年来血气分析的诊断正确率,发现少数死亡病例在临终前发生三重酸碱失衡(Triple Acid-Base Disorder, TABD),而在生前却未能识出,以致处理失当。究其原因在于:与临床资料脱节;未计算阴离子间隙(AG);未运用Arbus与Siggaard—Andersen酸碱图协助诊断及未按单一酸碱失衡代偿限度公式测算预期值。为了提高认识,选出四份病例进行探讨。 为了简便,下文以代酸、代碱、呼酸、呼碱分别代替各自的全词。我们把AG的正常高限定为16,所用的代偿限度计算公式为:
Recently, we examined the diagnostic accuracy of blood gas analysis over the past two years and found that a small number of deaths occurred in the Triple Acid-Base Disorder (TABD) before the dying. However, they were unidentified before their death, resulting in malnutrition. The reason is: out of line with the clinical data; did not calculate the anion gap (AG); not using Arbus and Siggaard-Andersen acid-base map to help diagnose and not according to a single acid-base imbalance compensation limit formula to estimate the expected value. In order to raise awareness, four cases were selected for discussion. For the sake of simplicity, the following text substitutes the whole word respectively with acid, alkali, acid, and alkali. We set the normal high limit of AG as 16, the compensation limit used is calculated as: