内分泌
词汇介绍
拓展阅读
解析
respiratory 英 /rɪˈspɪrət(ə)ri/ 美 /ˈrɛspərəˌtɔri/
释 义 adj. 呼吸的
释 义 respiration n. 呼吸；呼吸作用
respire vi. 呼吸
respire vt. 呼吸
例 句 Our ventilatory capacity—the ability to move oxygen in and out of our lungs — increases as we develop our respiratory muscles. 我们的呼吸能力---我们肺部输入和输出氧气的能力---随着我们呼吸肌肉的发达而提高。
acidosis 英 /,æsɪ'dəʊsɪs/ 美 /,æsɪ'dosɪs/
释 义 n. [内科] 酸中毒，酸毒症；酸液过多症
释 义 acidotic adj. 酸中毒的；[分化] 定酸量的
cidity n. 酸度；酸性；酸过多；胃酸过多
例 句 Acidosis can occur irrespective of the amount of oxygen in the air being breathed . 不管吸入的空气中的氧气量有多少酸中毒都可发生。
概述
概述
呼吸性酸中毒是一种医疗急症，其中通气量的减少（通气不足）会增加血液中二氧化碳的浓度，并降低血液的pH值（通常称为酸中毒）。作为人体细胞的呼吸作用二氧化碳连续地生产，如果肺不能通过肺泡通气充分排出，这种CO2会迅速累积。因此，肺泡通气不足会导致PaCO2升高（称为高碳酸血症）。增加的 CO2反过来降低了HCO3- / PaCO2比值，并且降低pH值。
原因
急性：当突然通气失败时，就会发生急性呼吸性酸中毒。这种通气衰竭可能是由于脑部疾病或药物引起的中央呼吸中枢抑制，神经肌肉疾病（如重症肌无力，肌萎缩性侧索硬化症，格林-巴利综合征，肌肉营养不良）或呼吸道阻塞导致的通气不足所致，与哮喘或慢性阻塞性肺疾病（COPD）加重有关。
慢性：慢性呼吸性酸中毒可能继发于许多疾病，包括COPD。COPD的通气不足涉及多种机制，包括对缺氧和高碳酸血症的反应性降低，通气-灌注不匹配增加，导致死腔通气增加以及继发于疲劳和过度充气的肌功能下降。
治疗方法
慢性呼吸性酸中毒的治疗重点在于治疗破坏呼吸过程和气体交换的潜在疾病。医生还可以提供改善呼吸的治疗方法，包括帮助打开肺部通道的药物。在急性呼吸性酸中毒中，医生可以通过口罩提供无创正压通气，称为Bi-PAP，这直接有助于呼吸。在更严重的情况下，医生可以通过将导管插入气道进行机械通气来改善呼吸。
预防
预防酸中毒的最好方法是避免引起疾病的原因。选择过无烟的生活方式可能会有所帮助，吸烟者患慢性呼吸性酸中毒的风险较高，吸烟对肺功能有害，它增加了呼吸系统疾病的风险，并且可能对整体生活质量产生不利影响。保持健康的体重可以减少这种情况的风险。服用镇静剂时要小心，它们会干扰呼吸能力，镇静剂可抑制中枢神经系统，绝不要超过建议的量，将镇静剂与酒精混合使用会有致命的风险。
Conduction disturbances caused by severe respiratory acidosis
复制标题
严重呼吸性酸中毒引起的传导障碍
发表时间：2019-09-11
影响指数：2.9
作者： Takashi Nakashima
期刊：J Cardiovasc Electrophysiol
Kagiyama et al1 reported increased PaCO2 (RA) decreased the maximum rate of rise of the action potential upstroke, and slowed conduction velocity in cardiac muscle. They also reported that these changes caused by RA were more rapidly and were of greater magnitude than the changes caused by metabolic acidosis. Therefore, it seems theoretically reasonable to suggest that RA might have possibly decreased conduction velocity in cardiac muscle, which resulted in PR prolongation, BBB, and broadening of the QRS width in the present case. The nonresponse of low BP to norepinephrine, the coma after discontinuation of anesthetics, and conduction disturbances were promptly reversed parallel to the normalization of the pH and PaCO2. These findings were compatible with acute CDN.In the case reported here, anesthetics including dexmedetomidine and thiopental were appropriately used and the airway was managed with a supraglottic airway device. Conduction disturbances sustained after the discontinuation of anesthetics. However, neither oversedation nor airway obstruction could be ruled out as possible causes of the severe RA. SAS and lower EF may contribute to the worsening of RA. Nonetheless, this is the first case report describing marked RA and subsequent CDN leading to various conduction disturbances during CA for AF in a clinical setting. General anesthesia during CA for AF improves contact force and decreases the fluoroscopy time and procedure time.3 Therefore, it can be presumed that CA under deep or moderate sedation or general anesthesia would be occasionally chosen. Electrophysiologists should be aware of CDN as an anesthesia‐associated complication during CA for AF under deep or moderate sedation or general anesthesia and that the subsequent clinical manifestations of CDN include various conduction disturbances such as PR prolongation, BBB, and broadening of the QRS width. To avoid RA during CA for AF, the carbon dioxide level should be monitored.
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