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混合性酸碱紊乱的分析,先从病史和体检着手,从这些资料可使临床医师推论特有的紊乱。然后对血浆碳酸氢盐、钾和氯的浓度以及阴离子隙的水平等电解质资料进行估价,其他实验室资料例如血浆肌氨酸酐或葡萄糖浓度,血液培养,等等,也可进一步检查,作为紊乱可能存在的线索。当临床需要对pH和PCO_2进行估价时,可从血气分析确定。如果检查所见的资料表明对这种紊乱的代偿是相应的,那么,等于提示甚少存在一种紊乱。如果代偿不相称,目前必定是混合性紊乱。在血浆HCO_3浓度或PCO_2异常的情况下,pH正常也提示混合性紊乱,因为代偿很少使pH恢复正常。当然,在已知的原发性紊乱pH异常更能确定混合性紊乱的诊断。所以,混合性酸碱紊乱的诊断以分析所有的临床资料为依据。而不仅仅测定血液气体。这种紊乱的治疗将是以维持pH在正常或接近正常水平为目的。重要的是对一些混合性酸碱紊乱要注意鉴别,因为它们可能由于pH的严重异常,需要立即进行特殊的治疗。pH接近正常的其他混合性紊乱的识别也是重要的,因为它们可提醒临床医师注意存在某些疾病例如败血症休克或药物中毒的可能性,按照这种方法,分析混合性紊乱是不困难的。并可提供临床医师关于诊断与治疗的重要知识来处理他的病人。
Mixed acid-base disorder analysis, starting with the medical history and physical examination, from which the clinician deduced the specific disorder. Electrolyte data such as plasma bicarbonate, potassium and chloride concentrations, and anion gap levels are then evaluated. Other laboratory data such as plasma creatinine or glucose concentration, blood cultures, etc. may also be further examined as possible There are clues. When the clinical needs of the pH and PCO_2 valuation, blood gas analysis can be determined. If the information found in the examination shows that the compensation for such disorders is appropriate, then there is little if any disruption to the prompts. If the compensation is disproportionate, it must be a mixed disorder at present. In cases of plasma HCO 3 or PCO 2 abnormalities, normal pH also suggests a mixed disorder, as compensations rarely return the pH to normal. Of course, a diagnosis of mixed disorders can be more accurately determined at known abnormalities in the pH of the primary disorder. Therefore, the diagnosis of mixed acid-base disorders to analyze all the clinical data as the basis. Not just blood gas. The treatment of this disorder will be to maintain the normal or near normal levels of pH for the purpose. It is important to be aware of some mixed acid-base disorders as they may require special treatment immediately due to a severe pH anomaly. The identification of other mixed disorders with near-normal pH is also important because they alert clinicians to the possibility of certain diseases such as septic shock or drug intoxication, according to which analysis of mixed disorders is not difficult. And can provide clinicians with important knowledge about diagnosis and treatment to deal with his patients.