— 生理適應 · EASY · MCQ —
一位慢性腎衰竭病人出現深且快的呼吸（Kussmaul breathing）。護理師預期血氣分析（ABG）結果為何？
A nurse is caring for a client with a history of chronic renal failure. The nurse notes the client has deep, rapid respirations. Which blood gas result should the nurse anticipate?
- ApH 7.35, PaCO2 50 mmHg, HCO3 26 mEq/LpH 7.35、PaCO2 50 mmHg、HCO3 26 mEq/L
- BpH 7.50, PaCO2 45 mmHg, HCO3 30 mEq/LpH 7.50、PaCO2 45 mmHg、HCO3 30 mEq/L
- CpH 7.30, PaCO2 35 mmHg, HCO3 18 mEq/L✓ 正解pH 7.30、PaCO2 35 mmHg、HCO3 18 mEq/L
- DpH 7.45, PaCO2 40 mmHg, HCO3 24 mEq/LpH 7.45、PaCO2 40 mmHg、HCO3 24 mEq/L
— Explanation · 中文詳解 —
慢性腎衰竭無法有效排出酸性代謝物，導致代謝性酸中毒。病人的深快呼吸（庫斯莫氏呼吸）是身體代償機制，透過過度換氣來排出二氧化碳以調控 pH 值。選項 C 代表代謝性酸中毒（低 pH、低 HCO3，PaCO2 代償性下降）。
Patients with chronic renal failure cannot effectively excrete acidic metabolites, leading to metabolic acidosis. The deep, rapid breathing (Kussmaul respirations) is a compensatory mechanism by which the body hyperventilates to blow off carbon dioxide and adjust the pH. Option C represents metabolic acidosis (low pH, low HCO3, with compensatory decrease in PaCO2).
✦ 台美臨床差異
兩地護理師皆需判讀 ABG，但台灣護理師常需等待醫師開立檢驗單，美國護理師在急重症單位常有權執行此類評估。