【摘要】 目的 探讨重症监护室(ICU)患者酸碱紊乱(ABD)的发生情况及其与临床结局的关系。方法 纳入eICU数据库中首个24 h内有血清白蛋白、pH、碳酸氢盐、二氧化碳分压、氯离子、钠离子和钾离子检测结果的ICU成年患者，并根据血液生化检验和动脉血气指标评估ABD类型。计算不同ABD类型中各疾病的患病率以及不同疾病中各ABD类型的发生率，并采用卡方检验计算不同ABD类型病死率间的差异。结果 共有13 363例患者被纳入，9 912例(74.2%)存在ABD。相较于无ABD患者，存在ABD的患者ICU病死率(9.9%vs. 18.9%,P<0.001)及住院病死率(15.9%vs. 25.9%,P<0.001)均明显增加。在整体ABD人群中，双重ABD的患病率最高(53.0%),其中以呼酸+代酸为主要类型(31.2%)。无论在哪种ABD类型的患者中，呼吸衰竭、休克和脓毒症的患病率均位居前三。在呼吸衰竭、休克、脓毒症、肺炎和肾衰竭的患者中，呼酸+代酸分别占到34.1%、32.9%、31.3%、32.6%和36.3%。在呼吸衰竭、休克、脓毒症和肾衰竭患者中，呼酸+代碱+高AG代酸者的ICU病死率(38.2%、46.0%、38.7%和38.3%)及住院病死率(48.8%、56.8%、50.0%和50.3%)最高。结论 ICU患者的ABD类型主要为呼酸+代酸。尽管呼酸+代碱+高AG代酸的患病率较低，但该类型的ICU病死率和住院病死率最高。在ICU患者的酸碱管理中，需及时评估患者的酸碱状态，尤其是早期识别呼酸+代碱+高AG代酸的情况。更多还原

【Abstract】 Objective To describe the occurrence of acid-base disturbance（ABD） in intensive care unit（ICU） patients and its relationship with clinical outcomes. Methods Adult ICU patients with serum albumin, pH, bicarbonate, PCO₂, chloride, sodium, and potassium levels measured within 24 hours of admisson were included from the eICU database. The type of ABD was evaluated based on blood biochemical tests and arterial blood gas indicators. The prevalence of each disease in different ABD types and the incidence of each ABD type in different diseases were calculated. The differences in mortality rates among different ABD subtypes were calculated by using the chi-square test. Results A total of 13 363 patients were included. 9 912 patients（74.2%） had ABD. Compared with patients without ABD, the ICU mortality rate（9.9% vs. 18.9%, P<0.001） and in-hospital mortality（15.9% vs. 25.9%, P<0.001） of patients with ABD were significantly increased. Among the overall ABD population, the prevalence of double ABD was the highest（53.0%）, with respiratory acidosis + metabolic acidosis being the main type（31.2%）. Regardless of the type of ABD, the prevalence of respiratory failure, shock, and sepsis ranked among the top three. Among the patients with respiratory failure, shock, sepsis, pneumonia and renal failure, respiratory acidosis combined with metabolic acidosis accounted for 34.1%, 32.9%, 31.3%, 32.6% and 36.3% of the cases, respectively. Among the patients with respiratory failure, shock, sepsis and renal failure, the ICU mortality rates（38.2%, 46.0%, 38.7%, and 38.3%）and in-hospital mortality（48.8%, 56.8%, 50.0%, and 50.3%） of those with respiratory acidosis + metabolic acidosis + high anion gap（AG） acidosis were the highest. Conclusions The main type of ABD in ICU patients is respiratory acidosis + metabolic acidosis. Although the prevalence of respiratory acidosis + metabolic alkalosis + high AG acidosis is relatively low, the ICU mortality rates and hospital mortality rates of this type are the highest. In the acid-base management of ICU patients, it is essential to assess their acid-base status promptly, particularly to identify respiratory acidosis, metabolic alkalosis, and high AG acidosis as early as possible.更多还原