心脏手术后的酸干扰:使用物理化学方法的队列研究
Marcello Guarnieri1, Antonio Mincolelli1, Filippo Serra1
1Department of Cardiothoracic and Vascular Anesthesia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Journal of cardiothoracic and vascular anesthesia
|October 23, 2025
概括
未测量的离子在心脏手术后显著导致代谢性酸性损伤,独立于乳酸水平. 使用斯图尔特模型进行先进的酸分析,可以更好地了解术后并发症.
科学领域:
- 关键护理医学 关键护理医学
- 进行心血管外科手术.
- 和电解质生理学的脏和电解质生理学.
背景情况:
- 代谢性酸症是心肺旁路术 (CPB) 的心脏手术后常见的术后并发症.
- 人们越来越认识到未测量的离子 (UA) 在这种酸性化中的作用.
- 斯图尔特物理化学模型提供了一个更全面的评估酸平衡.
研究的目的:
- 在心脏手术后的早期术后期调查酸变化.
- 用斯图尔特模型来描述未测量的离子 (UA) 对代谢酸性疾病的贡献.
- 将斯图尔特方法与传统的酸参数进行比较.
主要方法:
- 在单一的高等大学医院进行前性观察性研究.
- 包括50名接受CPB选择性心脏手术的成人患者.
- 在多个时间点使用传统和斯图尔特衍生变量进行全面的酸分析.
主要成果:
- 患者在ICU到达时呈现显著的代谢酸症,其特点是pH值低,乳酸盐升高,强离子间隙 (SIG) 显著增加.
- 升高的SIG在术后持续存在,这表明UA对化有显著的贡献,独立于超乳酸血症.
- 过多的乳酸基揭示了持续的非乳酸代谢障碍.
结论:
- 斯图尔特的方法突出了未测量的离子在心脏手术后的术后代谢酸症中的重要作用.
- 这些发现挑战了仅仅依赖乳酸和过量来评估酸状态的观点.
- 先进的酸分析可以改善手术后并发症的管理.
相关概念视频
Diagnosing Acidosis and Alkalosis
1.0K
Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
1.0K
Disorders of Acid-Base Balance
1.8K
The human body maintains a precise pH range of arterial blood between 7.35 and 7.45. Deviations result in either acidosis (pH < 7.35) or alkalosis (pH > 7.45). These conditions are further classified as respiratory or metabolic disorders based on their underlying cause.
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
1.8K
Bronsted-Lowry Acids and Bases
103.2K
The acid-base reaction class has been studied for quite some time. In 1680, Robert Boyle reported traits of acid solutions that included their ability to dissolve many substances, to change the colors of certain natural dyes, and to lose these traits after coming in contact with alkali (base) solutions. In the eighteenth century, it was recognized that acids have a sour taste, react with limestone to liberate a gaseous substance (now known to be CO2), and interact with alkalis to form neutral...
103.2K
Acid-Base Balance
2.2K
The human body maintains a narrow pH range regulated through acid-base balance. This balance is crucial as changes in the hydrogen ion concentration can disrupt cell membrane stability, alter protein structures, and change enzyme activities. The normal pH of arterial blood is 7.4, venous blood and interstitial fluid is 7.35, and intracellular fluid averages 7.0.
When the pH of arterial blood rises above 7.45, it results in a condition called alkalosis. Conversely, a drop below 7.35 leads to...
When the pH of arterial blood rises above 7.45, it results in a condition called alkalosis. Conversely, a drop below 7.35 leads to...
2.2K
Cardiomyopathy VII: Pre and Post Operative Nursing Management
283
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
283
Renal Regulation of Acid-Base Balance
1.5K
Metabolic reactions in the body produce nonvolatile acids, such as sulfuric acid, which generate an acid load of approximately 1 mEq of H+ per kilogram of body weight daily. Excreting H+ in the urine is essential to balance this acid load.
In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
However, the intercalated cells in...
In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
However, the intercalated cells in...
1.5K


