二碳酸的急性施用改善了试验性呼吸道酸化的通风效率:临床影响
Horacio J Adrogué1,2, Nicolaos E Madias3,4
1Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Pflugers Archiv : European journal of physiology
|March 27, 2024
概括
碳酸 (NaHCO3) 可能通过提高通风器效率来改善呼吸系统酸性,尽管有禁忌. 这项在狗身上进行的研究表明,NaHCO3在呼吸系统酸性疾病中增强呼吸,可能扭转肺功能缺陷.
科学领域:
- 生理学 生理学 生理学
- 呼吸系统医学 呼吸系统医学
- 酸平衡是指酸平衡的情况.
背景情况:
- 二碳酸盐 (NaHCO3) 的使用通常在呼吸系统酸性疾病中是禁忌的,因为人们担心二氧化碳负载增加和通风压力下降.
- 尽管有禁忌,但一些研究表明NaHCO3可能在呼吸系统酸性疾病中具有有益作用,但机制尚不清楚.
- 以前关于NaHCO3在呼吸系统酸性疾病中的有益作用的报道在很大程度上被忽视了.
研究的目的:
- 为了研究呼吸系统对高血压二碳酸 (NaHCO3) 输注的呼吸反应,在没有麻醉的呼吸系统酸症的狗中进行.
- 为了比较NaHCO3输液对呼吸系统酸性疾病中的通风的影响,与正常的酸状态和其他酸性疾病进行比较.
- 阐明潜在地解释NaHCO3在呼吸系统酸性疾病中观察到的影响的潜在机制.
主要方法:
- 经过实验诱导的呼吸系统酸化的未经麻醉的狗被输注高性NaHCO3 (1N,5 mmol/kg).
- 通过测量二氧化碳 (PaCO2) 部分压力变化和PaCO2与pH关系来评估通风反应.
- 与具有正常酸状态或其他酸障碍的对照组进行了比较.
主要成果:
- 在呼吸系统酸症中,PaCO2没有增加,并且PaCO2的变化与pH的变化 (ΔPaCO2/ΔpH) 斜率在NaHCO3输注后是负的.
- 相反,在其他酸性疾病组中,PaCO2持续增加,ΔPaCO2/ΔpH斜率为正值.
- 这些发现独立于缓冲效应,基线pH,PaCO2或通风水平.
结论:
- 二碳酸盐 (NaHCO3) 输液似乎可以提高呼吸系统的效率 (降低VE/VCO2),特别是在呼吸系统酸性疾病中.
- 这种效应可能源于NaHCO3逆转了由支气管收缩和肺血流减少引起的死空间/潮体积 (VD/VT) 的基线增加.
- 这项研究为先前报告的NaHCO3在急性呼吸系统酸性病患者的有益作用提供了潜在的解释.
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