- 期刊
嬰兒腹瀉導致嚴重代謝性酸中毒合併急性呼吸衰竭之治療
Treatment of Metabolic Acidosis Associated with Acute Respiratory Failure in Diarrhea of Infancy
摘要
嬰兒患上吐下瀉，引起脫水及代謝性酸中毒是臨床上常見疾病之一。極端酸中毒如未能及時適當處置，則呼吸中樞將受到抑制而引起呼吸衰竭，甚至導致死亡。現有8個月大的男嬰，即因上吐下瀉送至榮總急診室，當時已經是深昏迷，兩側瞳孔散大，呼吸淺又慢。其氣體分析顯示嚴重的代謝性酸中毒合併有急性呼吸衰竭(pH=6.80, Po2=46mmHg, Pco2=60mmHg, actual bicarbonate=8.8mEg/L, base excess=-26mEq/L)。經適當治療後，病人迅速恢復，一星期後痊愈出院。出院後，經兩年追踪，病患之生長及發育完全正常，證明沒有任何後遺症狀。類如此嚴重病例的治療成功，實屬難能可貴。故將此個案提出報告，並討論這種複雜酸鹼平衡失調之氣體分析、研判、及矯正方法。並參考文獻，加以申論之。
關鍵字
無資料並列摘要
The gas analysis has become a commonly used technic in recent years. Though the treatment of simple metabolic acidosis caused by diarrhea is usually no longer a problem that of severe metabolic acidosis complicated with respiratory failure remains a challenge, however, to the clinician. A 8-month-old male infant, who had had diarrhea and was not treated well, was brought to the Emergency Room of the Veterans General Hospital. He was in deep coma; the pupils were dilated with no demonstrable light reflex; respiration was shallow and slow. The results of gas analysis were: pH, 6.80; Po2, 48 mmHg; Pco2, 60 mmHg; BE, -26mEq/L; acutal bicarbonate, 8.8mEq/L. The patient was proved in severe metaboilc acidosis associated with acute respiratory failure. Following the quick and proper management, the baby recovered from the disaster. He was discharged one week after admission. The acidosis was corrected gradually by titration with sodium bicarbonate. Two years later, he was found normal in terms of both growth and development. Some problems in the treatment of severe metabolic acidosis with acute respiratory failure were discussed.