- 期刊
Evaluation of Acid-Base Disorders in Two Patients Using Stewart's Approach
以斯圖爾特方式著手處置臨床酸鹼問題
摘要
酸鹼平衡的異常可能起因於嚴重細胞或全身性代謝問題引起。監控血液pH值對臨床重症病患的評估與處置以及了解其潛在之病生理極其重要。傳統著手處理酸鹼平衡異常，多依循亨德森-黑索巴克公式(Henderson-Hasselbalch equation)原理處置，其主要著眼於血中重碳酸(HCO(上標 -)3)濃度的改變、二氧化碳的分壓(pCO2)以及二氧化碳(CO2)的溶解度這三方面。然而斯圖爾特處置(Stewart's approach)是基於分析血液內複雜的各種陰陽離子（強離子）及各種弱酸性蛋白質、磷酸、乳酸等對水釋放氫離子的影響，以期了解更精確及完整的酸鹼失衡機制及原理。在這篇回顧裡，我們經由兩個酸鹼失衡病例的介紹，讓讀者了解由傳統著手處理與由斯圖爾特方式處置的差異。
並列摘要
Disturbances of acid-base balance can result from serious cellular and general consequences. Monitoring of blood pH is clinically important to evaluate and understand the physiological condition of a critically ill patient. The traditional approach to acid-base equilibrium based on the Henderson-Hasselbalch equation focuses on changes in the concentration of bicarbonate (HCO(superscript -)3), the partial pressure of carbon dioxide (pCO2), the dissociation constant and the solubility of CO2. The Stewart's approach, however, based on the analysis of the complex components of physiologic fluid, such as sodium (Na(superscript +)), potassium (K(superscript +)), calcium (Ca(superscript 2+)), magnesium (Mg(superscript 2+)), chloride (Cl(superscript -)), pCO2, lactate, phosphorus, and protein, provides better information and a more accurate conceptual view of acid-base mechanism. In this review, we evaluate two cases of acid-base disturbance, one after major surgery, and the other after liver transplantation, using the Stewart’s approach, and compare it with the traditional approach.