2. دانش رابانوشتن پایبندکنید،آنچه حفظ شودبگریزد وآنچه نوشته شود برقرار ماند. امام علی ( ع ) Arterial Blood Gas interpretation بررسی وتفسیر گازهای خونی بررسی وتفسیر گازهای خونی ABGABG

3. Definition Blood gas analysis, also called arterial blood gas (ABG) analysis, is a test which measures the amounts of oxygen and carbon dioxide in the blood, as well as the acidity (pH) of the blood. Blood gas analysis, also called arterial blood gas (ABG) analysis, is a test which measures the amounts of oxygen and carbon dioxide in the blood, as well as the acidity (pH) of the blood. Blood gas analysis is performed on blood from an artery. Blood gas analysis is performed on blood from an artery. In addition, the acid-base component of the test provides information on kidney function. In addition, the acid-base component of the test provides information on kidney function.

4. PH (puissance Hydrogen) The negative logarithm of the hydrogen ion concentration (activity). The mathematical equation is: pH= -log [H+]. Normally, the average in-vivo hydrogen ion concentration is between 1 x 10 -7 moles/liter (a pH of 7) and 1 x 10 -8 moles/liter (a pH of 8). In blood, the pH represents the relationship between the respiratory and the metabolic systems. A normal pH in the human body is between 7.35- 7.45. PH (puissance Hydrogen) The negative logarithm of the hydrogen ion concentration (activity). The mathematical equation is: pH= -log [H+]. Normally, the average in-vivo hydrogen ion concentration is between 1 x 10 -7 moles/liter (a pH of 7) and 1 x 10 -8 moles/liter (a pH of 8). In blood, the pH represents the relationship between the respiratory and the metabolic systems. A normal pH in the human body is between 7.35- 7.45.

5. pH must remain within normal limits or the body will die. The respiratory and metabolic systems work together to maintain balance. The respiratory system begins to compensate (when there are imbalances) immediately while the metabolic system may take days to compensate. Compensation may be partial or complete. A compensated situation may also be termed as chronic. Stated simply, partial compensation occurs when the unaffected system is attempting to compensate, although the pH is not within normal range. Complete compensation occurs when the unaffected system compensates to a nearly normal pH.

6. PaO 2 Arterial oxygen tension (pressure) measured in millimeters of mercury (mmHg) or in Torr. This represents the amount of dissolved oxygen in the blood. The normal values for PaO 2 are between 80-100 mmHg for an adult and child, 40-70 mmHg for a newborn and 60-80 mmHg for those 60-90 years old. PaO 2 and PO 2 will be used interchangeably.

7. PCO 2 Arterial carbon dioxide tension (pressure) measured in millimeters of mercury (mmHg) or in Torr. This is dissolved carbon dioxide in the blood. This represents the respiratory component. Normal values are 35-45 mmHg. PaCO 2 and PCO 2 will be used interchangeably.

8. HCO 3- The bicarbonate ion. This represents the metabolic component. It is expressed in milliequivalents per liter (mEq/l). Normal values are 22-28 mEq/l.

9. SaO 2 This is the oxygen saturation measured in arterial blood (SaO 2 ) or transcutaneously by the pulse (SpO 2 ) with an external probe (usually placed on the finger). This is representative of the amount of oxygen bound to hemoglobin. Theoretically, anything greater than 90% is acceptable. This is a very simple way to measure trends. However, this number will be inaccurate with dyshemoglobinemias, poor peripheral perfusion (cold hands may not read accurately), anemia,hana, dyes and pigments (methylene blue, indocyanine green and bilirubin) and sometimes external light sources.

11. Dyshemoglobins.There are a number of hemoglobins that malfunction, causing an alteration in their binding sites. These are termed dyshemoglobins. They may bind with many different molecules..There are three main dyshemoglobins: Carboxyhemoglobin (COHb) - in which Hb binds with carbon monoxide (CO), Methemoglobin (MetHb) - in which the ferrous ion (Fe++)oxidizes to the ferric state (Fe+++), and Fetal hemoglobin (HbF).

12. Carboxyhemoglobin Carbon monoxide has approximately 200 times the affinity for Hb than does O 2. This means that once CO has bound to the Hb it is very difficult for the O 2 to bind. It takes many hours for the CO to release the Hb and make it available to O 2 once again. The amount of CO bound to Hb is of vital importance with smoke inhalation victims (and sometimes heavy smokers). In the case of carbon monoxide poisoning, an oximeter (SO 2 measuring device) is of little value. An oximeter reads the total amount of bound Hb (not just O 2 bound to Hb).

13. Interpretation Guidelines Step 1: Look at pH - this is the starting point.Step 1: Look at pH - this is the starting point. 1.If within normal range, a normal or compensated state exists. 2.If outside normal limits, assess whether acidosis or alkalosis is present. 3.The body never overcompensates. Whichever state exists on the pH scale is the primary abnormality.

14. Step 2: Assess hypoxemic state. 1.If PaO2 is <60 mmHg, hypoxic state exists. 2.If PaO2 is between 80 -100 mmHg, a normal condition exists. 3.If PaO2 is >100 mmHg, a hyperoxic state exists.

15. Step 3: Assess ventilatory status. 1.If PaCO2 is <35 mmHg, it is termed "alkalosis" (alveolar hyperventilation or hypocarbia). 2.If PaCO2 is between 35-45 mmHg, it is within normal limits. 3.If PaCO2 is >45 mmHg, it is termed "acidosis" (ventilatory failure or hypercarbia). 4.If possible, determine whether this is an acute or chronic state (see the compensation explanation).

16. Step 4: Assess metabolic component. 1.If bicarbonate (HCO3-) is <22 mEq/l it is termed "acidosis". 2.If bicarbonate is between 22-28 mEq/l, it is within normal limits. 3.If bicarbonate is >28 mEq/l, it is termed "alkalosis". Mohammad Ali Salehi Shahrivar 1388 4.If possible, determine whether this is an acute or chronic state

17. Acute ventilatory failure (acute respiratory acidosis) Classification : pH v PaCO2 ^ HCO3-N

18. Chronic ventilatory failure (compensated respiratory acidosis) pH or N PaCO2 HCO3 Vali-e-asr hospital Eghlid

19. Acute alveolar hyperventilation (acute respiratory alkalosis) pH PaCO2 HCO3- N

20. Chronic alveolar hyperventilation (compensated respiratory alkalosis) pH ^ N PaCO2 v HCO3- v

21. Acute metabolic acidosis pH v PaCO2 N HCO3- v

22. Chronic metabolic acidosis pH v or N PaCO2 v HCO3- v

23. Acute metabolic alkalosis pH ^ PaCO2 N HCO3- ^

24. Chronic metabolic alkalosis pH ^ N PaCO2 ^ HCO3- ^

25. Hint: in compensated states, the PaCO 2 and HCO 3 - have matching arrows (directions).

28. بررسی آزمایش گازهای خون چند بیمار آقای محمدی 74 ساله بعد ازیک سکته مغزی دربخش داخلی بستری شده است. امروزدرمقایسه با روزهای قبل بی حال هستند. دربررسی ریه ها متوجه کاهش هوادرلبهای پایین ریه می شویم نتایج آزمایش ایشان چنین است. آقای محمدی 74 ساله بعد ازیک سکته مغزی دربخش داخلی بستری شده است. امروزدرمقایسه با روزهای قبل بی حال هستند. دربررسی ریه ها متوجه کاهش هوادرلبهای پایین ریه می شویم نتایج آزمایش ایشان چنین است. PH=7.33 Pco2=55 Hco3-=29 Pao2=57 PH=7.33 Pco2=55 Hco3-=29 Pao2=57 مشکل بیمارچیست؟ مشکل بیمارچیست؟

29. خانم بهرامی 35 ساله جهت برداشتن کیسه صفرا تحت عمل جراحی قرار گرفته وبه علت درد واضطراب هنگامی که ازوی خواسته می شود که راه برود یا برروی صندلی بنشیند دچارافزایش تنفس می گردد. او ازاحساس واردشدن سوزن درانگشتان شکایت می کند. نتایج آزمایش وی چنین است : خانم بهرامی 35 ساله جهت برداشتن کیسه صفرا تحت عمل جراحی قرار گرفته وبه علت درد واضطراب هنگامی که ازوی خواسته می شود که راه برود یا برروی صندلی بنشیند دچارافزایش تنفس می گردد. او ازاحساس واردشدن سوزن درانگشتان شکایت می کند. نتایج آزمایش وی چنین است : PH=7.55 Paco2=28 Hco3-=24 PH=7.55 Paco2=28 Hco3-=24 مشکل بیمارچیست؟ مشکل بیمارچیست؟

30. آقای حسینی 54 ساله مبتلا به بیماری نکروزحادتیوبولها با ایست قلبی ریوی به بیمارستان آورده شده وبا اولین شوک دفیبریلاتوربرگشته، نتایج آزمایش ایشان چنین است. آقای حسینی 54 ساله مبتلا به بیماری نکروزحادتیوبولها با ایست قلبی ریوی به بیمارستان آورده شده وبا اولین شوک دفیبریلاتوربرگشته، نتایج آزمایش ایشان چنین است. PH=7.32 Pco2=34 Hco3-=17 PH=7.32 Pco2=34 Hco3-=17 مشکل بیمارچیست؟ مشکل بیمارچیست؟

31. خانم صبوری 60 ساله تاریخچه زخم دستگاه گوارش می دهد،چندروزقبل ازبستری شدن دچاراستفراغ شده است. برای ایشان لوله معده گذاشته وبه دستگاه مکنده وصل شده ،نتایج آزمایش ایشان چنین است. خانم صبوری 60 ساله تاریخچه زخم دستگاه گوارش می دهد،چندروزقبل ازبستری شدن دچاراستفراغ شده است. برای ایشان لوله معده گذاشته وبه دستگاه مکنده وصل شده ،نتایج آزمایش ایشان چنین است. PH=7.52 Pco2=49 Hco3-=40 PH=7.52 Pco2=49 Hco3-=40 مشکل بیمارچیست؟ مشکل بیمارچیست؟

32. با تشکر ازتوجه شما همکارگرامی محمدعلی صالحی کارشناس پرستاری بیمارستان ولیعصر ( عج ) اقلید محمدعلی صالحی کارشناس پرستاری بیمارستان ولیعصر ( عج ) اقلید سال 1388 سال 1388