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鍙嬫儏鎻愮ず锛氭湰绔欐彁渚涘叏鍦�400澶氭墍楂樼瓑闄㈡牎鎷涙敹纰╁＋銆佸崥澹爺绌剁敓鍏ュ鑰冭│姝峰勾鑰冪爺鐪熼銆佽€冨崥鐪熼銆佺瓟妗�锛岄儴鍒嗗鏍℃洿鏂拌嚦2012骞达紝2013骞达紱鍧囨彁渚涙敹璨讳笅杓�銆� 涓嬭級娴佺▼锛� 鑰冪爺鐪熼 榛炴搳鈥�鑰冪爺瑭﹀嵎鈥濃€濅笅杓�; 鑰冨崥鐪熼 榛炴搳鈥�鑰冨崥瑭﹀嵎搴�鈥� 涓嬭級
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鑰冭│绉戠洰浠ｇ⒓锛� 鑰冭│绉戠洰鍚嶇ū锛氱敓鐞嗗
涓€銆佽│鍗风祼(ji茅)妲�(g貌u)
1) 瑭﹀嵎鎴愮妇鍙婅€冭│鏅傞枔
鏈│鍗锋豢鍒嗙偤 100 鍒嗭紝鑰冭│鏅傞枔鐐� 180 鍒嗛悩銆�
2)绛旈鏂瑰紡锛氶枆鍗枫€佺瓎瑭�
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浜�銆佽€冭│鍏�(n猫i)瀹硅垏鑰冭│瑕佹眰
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鐨勫熀鏈蹇点€�
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绗簩绔� 绱拌優鐨勫熀鏈姛鑳�
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锛�2锛夌啛鎮夐洟瀛愰€氶亾銆丟 铔嬬櫧鑰﹁伅(li谩n)鍙楅珨鍜岄叾鑰﹁伅(li谩n)鍙楅珨浠嬪皫鐨勫咕绋富瑕佺殑璺ㄨ啘淇¤櫉杞�(zhu菐n)灏庢柟
寮忓拰姗熷埗銆�
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闆讳綅鍜屽悗闆讳綅浠ュ強闁鹃浕浣嶅拰灞€閮ㄥ弽鎳�(y墨ng)鐨勬蹇�锛岄潨鎭浕浣嶅拰鍕曚綔闆讳綅鐨勭敘(ch菐n)鐢熸鍒�锛岃垐濂湪鍚屼竴
绱拌優涓婂偝灏庣殑鏂瑰紡锛屽嫊浣滈浕浣嶅拰灞€閮ㄥ弽鎳�(y墨ng)鐨勭壒榛烇紝鐔熸倝绱拌優鑸堝ギ鎬у懆鏈熸€ц畩鍖栫殑瑕�(gu墨)寰�銆�
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锛�5锛変簡瑙ｆ┇绱嬭倢鐨勭窗寰祼(ji茅)妲�(g貌u)锛屾帉鎻℃┇绱嬭倢鐨勬敹绺鍒�銆佽垐濂�-鏀剁府鑰﹁伅(li谩n)鐨勬蹇靛強姗熷埗锛�
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绗笁绔� 琛€ 娑�
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鎺у埗姗熷埗锛堣绠″収(n猫i)鐨殑鎶楀嚌浣滅敤锛岀簴缍泲鐧界殑鍚搁檮銆佽娴佺殑绋€閲嬪拰鍠牳宸ㄥ櫖绱拌優鐨勫悶鍣綔鐢�锛�
绲叉皑閰歌泲鐧介叾鎶戝埗鐗�銆佽泲鐧借唱(zh矛) C 绯荤当(t菕ng)銆佺祫绻斿洜瀛愰€斿緫鎶戝埗鐗�銆佽倽绱犵瓑鐢熺悊鎬ф姉鍑濈墿璩�(zh矛)鐨勪綔
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鍘熺ó椤炪€佺壒榛炲拰鑷ㄥ簥鎰忕京锛�銆佽几琛€鍘熷墖銆�
绗洓绔� 琛€娑插惊鐠�(hu谩n)
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鐨勬蹇碉紝浜嗚В蹇冮浕鍦栫殑鍩烘湰娉㈠舰鍙婂悇娉㈠拰闁撴湡鐨勬剰缇�銆�
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鍙婂奖闊垮洜绱�锛屼簡瑙ｆ穻宸存恫鐢熸垚鑸囧洖娴佺殑姗熷埗鍙婂奖闊垮洜绱�銆佹穻宸村洖娴佺殑鐢熺悊鎰忕京銆�
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浜嗚В琛€绠″崌澹撶礌銆佽绠＄敓鎴愮殑琛€绠℃椿鎬х墿璩�(zh矛)銆佹縺鑲介噵鏀鹃叾-婵€鑲界郴绲�(t菕ng)銆佸績鎴块垑灏胯偨銆佸墠鍒楄吅
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鍕曡剤琛€澹撶殑鐭湡瑾�(di脿o)绡€(ji茅)鍜岄暦鏈熻(di脿o)绡€(ji茅)銆�
锛�10锛夌啛鎮夊啝鑴堝惊鐠�(hu谩n)鐨勮В鍓栫壒榛�銆佽娴佺壒榛炲強鍏惰娴侀噺鐨勮(di脿o)绡€(ji茅)姗熷埗锛岃偤寰挵(hu谩n)鐨勭敓鐞嗙壒榛�
鍜岃娴侀噺鐨勮(di脿o)绡€(ji茅)姗熷埗锛岃叇寰挵(hu谩n)鐨勭敓鐞嗙壒榛�銆佽娴侀噺鐨勮(di脿o)绡€(ji茅)姗熷埗銆佽叇鑴婃恫鐨勭敓鎴愬拰鍚告敹姗熷埗銆�
琛€-鑵﹁剨娑插睆闅滃拰琛€-鑵﹀睆闅滅殑姒傚康銆�
绗簲绔� 鍛� 鍚�
锛�1锛夋帉鎻″懠鍚哥殑姒傚康鍙婂叾鍚勭挵(hu谩n)绡€(ji茅)鐨勫熀鏈亷绋嬨€�
锛�2锛夋帉鎻¤偤閫氭埃鐨勫嫊鍔涳紙鐩存帴鍕曞姏鑸囧師鍕曞姏锛�銆佽吂寮忓懠鍚歌垏鑳稿紡鍛煎惛銆佸钩闈滃懠鍚歌垏鐢�
鍔涘懠鍚哥殑姒傚康銆佽偤鍏�(n猫i)澹撹垏鑳歌啘鑵斿収(n猫i)澹撶殑璁婂寲姗熷埗銆佽偤閫氭埃鐨勫綀鎬ч樆鍔涜垏鑲烘场琛ㄩ潰寮靛姏銆侀爢鎳�(y墨ng)
鎬ц垏姣旈爢鎳�(y墨ng)鎬�銆佽偤娉¤〃闈㈡椿鎬х墿璩�(zh矛)鐨勭敓鐞嗕綔鐢�锛屼簡瑙ｉ潪褰堟€ч樆鍔涘拰褰遍熆姘ｉ亾闃诲姏鐨勫洜绱�銆�
锛�3锛夌啛鎮夎偤閫氭埃鍔熻兘鐨勬寚妯欙紙鑲哄绌�銆佹疆姘ｉ噺銆佽鍚告埃閲忋€佽鍛兼埃閲�銆佷綑姘ｉ噺銆佽偤瀹�
閲�銆佹繁鍚告埃閲�銆佸姛鑳戒綑姘ｉ噺銆佽偤娲婚噺鑸囩敤鍔涜偤娲婚噺銆佺敤鍔涘懠姘ｉ噺銆佽偤绺介噺銆佽偤閫氭埃閲忋€佹渶澶�
闅ㄦ剰閫氭埃閲�銆侀€氭埃鍎查噺鐧惧垎姣�銆佺劇鏁堣厰鍙婅偤娉￠€氭埃閲�銆佸懠鍚稿姛锛夈€�
锛�4锛夌啛鎮夋埃楂斾氦鎻涚殑鍘熺悊鍙婂奖闊垮洜绱狅紙姘ｉ珨鐨勫垎澹撳樊銆佸垎瀛愰噺銆佹憾瑙ｅ害銆佹埃楂旀摯鏁ｇ殑
闈㈢⿳鍜岃窛闆�銆佹韩搴︼級銆佽娑茶垏鑲烘场鍜岀祫绻旀恫鍏�(n猫i)姘ｉ珨鐨勫垎澹撳€�銆佸奖闊胯偤鎻涙埃鐨勫洜绱狅紙鍛煎惛鑶滅殑
闈㈢⿳鑸囧帤搴︺€侀€氭埃/琛€娴佹瘮鍊硷級銆�
锛�5锛夌啛鎮夋埃楂斿湪琛€娑蹭腑鐨勯亱杓稿舰寮�锛屾帉鎻¤绱呰泲鐧界殑姘у閲�銆佹哀鍚噺鍜屾哀椋藉拰搴︾殑姒�
蹇碉紝浜嗚В姘цВ闆㈡洸绶氳垏浜屾哀鍖栫⒊瑙ｉ洟鏇茬窔鍙婂叾褰遍熆鍥犵礌銆�
锛�6锛夋帉鎻′綆浣嶈叇骞茬殑鍛煎惛绁炵稉(j墨ng)鍏冭垏鍛煎惛瑾�(di脿o)鏁翠腑妯炲皪鍛煎惛鐨勮(di脿o)绡€(ji茅)浣滅敤锛屼簡瑙ｅ懠鍚哥瘈(ji茅)寰嬬殑
褰㈡垚姗熷埗銆佽剨楂撳拰楂樹綅鑵﹀皪鍛煎惛鐨勮(di脿o)绡€(ji茅)浣滅敤锛屾帉鎻¤偤鐗藉嫉鍙嶅皠銆佸寲瀛告劅鍙楁€у弽灏勶紙澶栧懆鍖栧
鎰熷彈鍣ㄨ垏涓鍖栧鎰熷彈鍣�锛岃娑� CO2銆丠
+
銆丱2 婵冨害鐨勮畩鍖栧皪鍛煎惛娲诲嫊鐨勫奖闊垮強鍏朵綔鐢ㄦ鍒讹級锛�
浜嗚В鍛煎惛鑲岀殑鏈珨鎰熷彈鎬у弽灏�銆佸挸鍡藉弽灏�銆佸櫞鍤忓弽灏勩€佽偤姣涚窗琛€绠℃梺绱拌優鎰熷彈鍣ㄥ弽灏�銆�
绗叚绔� 娑堝寲鍜屽惛鏀�
锛�1锛夋帉鎻℃秷鍖栬垏鍚告敹銆佹姊版€ф秷鍖栬垏鍖栧鎬ф秷鍖栫殑姒傚康锛岀啛鎮夋秷鍖栭亾骞虫粦鑲岀殑涓€鑸敓
鐞嗙壒鎬у強鍏堕潨鎭浕浣�銆佸熀鏈浕绡€(ji茅)寰�銆佸嫊浣滈浕浣嶄互鍙婁笁鑰呯殑闂�(gu膩n)绯伙級锛屼簡瑙ｆ秷鍖栭亾鍏�(n猫i)鍦ㄧ缍�(j墨ng)鍜屽
渚嗙缍�(j墨ng)鐨勪綔鐢ㄥ強鍏剁浉浜掗棞(gu膩n)绯�銆佽儍鑵告縺绱犲拰鑵﹁吀鑲界殑姒傚康銆佽儍鑵歌娴佺殑涓€鑸壒榛�銆�
锛�2锛変簡瑙ｅ斁娑茬殑鎬ц唱(zh矛)浠ュ強鎴愬垎鍜屼綔鐢ㄣ€佸斁娑插垎娉岀殑瑾�(di脿o)绡€(ji茅)銆佸拃鍤肩殑鎰忕京銆佸悶鍜界殑閬庣▼銆�
椋熼亾鐨勮爼鍕曘€侀閬撹儍鎷磩鑲岀殑浣滅敤銆�
锛�3锛夋帉鎻¤儍娑茬殑鎬ц唱(zh矛)鍙婂叾涓昏鎴愬垎鍜屼綔鐢�銆佺矘娑测€旂⒊閰告矮楣藉睆闅滆垏鑳冪矘鑶滃睆闅滅殑姒傚康銆�
鑳冩帓绌虹殑姒傚康鍙婂奖闊垮洜绱�锛岀啛鎮夊熀绀�(ch菙)閰告帓鍑洪噺鑸囪儍娑查吀搴︾殑鑷ㄥ簥鍠綅銆佸埡婵€鑳冩恫鍒嗘硨鐨勫収(n猫i)婧�
鎬х墿璩�(zh矛)銆佹姂鍒惰儍閰稿垎娉岀殑鍏�(n猫i)婧愭€х墿璩�(zh矛)銆佹秷鍖栨湡鑳冩恫鍒嗘硨鐨勮(di脿o)绡€(ji茅)姗熷埗锛堥牠鏈�銆佽儍鏈熷拰鑵告湡锛�銆�
鑳冩恫鍒嗘硨鐨勬姂鍒舵€ц(di脿o)绡€(ji茅)锛屼簡瑙ｈ儍闋崁(q奴)鍜屽熬鍗€(q奴)鐨勯亱鍕曞強鍏舵剰缇┿€佽儍閬嬪嫊鐨勮(di脿o)绡€(ji茅)鍜屽様鍚愮殑鎰忕京鍜�
姗熷埗銆�
锛�4锛夋帉鎻¤儼娑茬殑鎬ц唱(zh矛)浠ュ強鎴愬垎鍜屼綔鐢ㄣ€佽儼娑插垎娉岀殑瑾�(di脿o)绡€(ji茅)锛堥牠鏈�銆佽儍鏈熷拰鑵告湡锛�銆佽喗姹�
鐨勬€ц唱(zh矛)浠ュ強鎴愬垎鍜屼綔鐢�銆佽喗楣界殑鑵歌倽寰挵(hu谩n)銆佽喗姹佸垎娉屽拰鎺掑嚭鐨勮(di脿o)绡€(ji茅)锛岀啛鎮夊皬鑵告恫鐨勬€ц唱(zh矛)浠ュ強
鎴愬垎鍜屼綔鐢�銆佸皬鑵告恫鍒嗘硨鐨勮(di脿o)绡€(ji茅)銆佸皬鑵搁亱鍕曠殑褰㈠紡鍜屼綔鐢�锛屼簡瑙ｅ洖鐩茬摚鐨勫姛鑳�銆佸皬鑵搁亱鍕曠殑
瑾�(di脿o)绡€(ji茅)姗熷埗銆�
锛�5锛変簡瑙ｅぇ鑵告恫鐨勫垎娉�銆佸ぇ鑵搁亱鍕曞舰寮忓拰鎺掍究鍙嶅皠銆佸ぇ鑵稿収(n猫i)绱拌弻鐨勪綔鐢�銆�
锛�6锛夌啛鎮夊惛鏀剁殑閮ㄤ綅銆侀€斿緫鑸囨鍒朵互鍙婂咕绋富瑕佺墿璩�(zh矛)鐨勫惛鏀舵鍒�锛屼簡瑙ｅぇ鑵哥殑鍚告敹鍔�
鑳�銆�
绗竷绔� 鑳介噺浠ｈ瑵鍜岄珨婧�
锛�1锛夌啛鎮夎兘閲忎唬璎濈殑姒傚康銆佽兘閲忓湪楂斿収(n猫i)鐨勮綁(zhu菐n)鍖栥€侀鐗╃殑鐔卞児銆佹哀鐔卞児銆佸懠鍚稿晢銆侀潪铔�
鐧藉懠鍚稿晢銆佸奖闊胯兘閲忎唬璎濈殑涓昏鍥犵礌銆佽兘閲忎唬璎濇脯瀹氭柟娉�锛屾帉鎻″熀绀�(ch菙)浠ｈ瑵鑸囧熀绀�(ch菙)浠ｈ瑵鐜囩殑姒�
蹇靛強鍏舵脯瀹氱殑鏂规硶鍜屾剰缇┿€�
锛�2锛夌啛鎮夐珨婧殑姒傚康銆佹甯稿€煎強鍏舵甯歌畩鍕�銆佹楂旂敘(ch菐n)鐔卞舰寮忋€佷富瑕佺敘(ch菐n)鐔卞櫒瀹樺拰鐢�(ch菐n)鐔辨椿
鍕曠殑瑾�(di脿o)绡€(ji茅)姗熷埗銆佹楂旀暎鐔辨柟寮忓拰鏁ｇ啽娲诲嫊鐨勮(di脿o)绡€(ji茅)姗熷埗銆佽嚜涓荤缍�(j墨ng)鎬ч珨婧(di脿o)绡€(ji茅)鑸囪鐐烘€ч珨婧(di脿o)
绡€(ji茅)鐨勬蹇�銆佸鍛ㄦ韩搴︽劅鍙楀櫒鍜屼腑妯炴韩搴︽劅鍙楀櫒銆侀珨婧(di脿o)绡€(ji茅)涓鐨勫姛鑳芥椿鍕曡垏楂旀韩瑾�(di脿o)瀹氶粸瀛歌銆�
绗叓绔� 灏跨殑鐢熸垚鍜屾帓鍑�
锛�1锛夌啛鎮夋帓娉勭殑姒傚康鍜岄€斿緫銆佽厧鑷熸帓娉勭殑鐢熺悊鎰忕京銆佸翱娑茬殑鐞嗗寲鎬ц唱(zh矛)銆佸翱閲忥紙鍚灏裤€�
灏戝翱鍜岀劇灏跨殑姒傚康锛�銆�
锛�2锛変簡瑙ｈ厧鍠綅鑸囬泦鍚堢鐨勭祼(ji茅)妲�(g貌u)銆佺毊璩�(zh矛)鑵庡柈浣嶅拰杩戦珦鑵庡柈浣嶇殑鐗归粸锛岀啛鎮夌悆鏃佸櫒鐨勫姛
鑳�銆佹烤閬庤啘鐨勭祼(ji茅)妲�(g貌u)鍜屽姛鑳界壒榛炪€佽厧琛€娴佷緵鎳�(y墨ng)鐗归粸銆佽厧琛€娴侀噺鐨勮嚜韬(di脿o)绡€(ji茅)锛堣倢婧愭€ф鍒跺拰绠�-
鐞冨弽楗嬶級銆佽厧琛€娴侀噺鐨勭缍�(j墨ng)瑾�(di脿o)绡€(ji茅)鍜岄珨娑茶(di脿o)绡€(ji茅)姗熷埗銆�
锛�3锛夋帉鎻¤厧灏忕悆鏈夋晥婵鹃亷澹�銆佽厧灏忕悆婵鹃亷鐜囥€佹烤閬庡垎鏁�(sh霉)銆佹烤閬庣郴鏁�(sh霉)鐨勬蹇靛拰褰遍熆鑵庡皬
鐞冩烤閬庣殑鍥犵礌銆�
锛�4锛変簡瑙ｈ厧灏忕鑸囬泦鍚堢鐨勭墿璩�(zh矛)杞�(zhu菐n)閬嬫柟寮忓拰閫斿緫锛堣法绱拌優杞�(zhu菐n)閬嬮€斿緫鍜岀窗鑳炴梺杞�(zhu菐n)閬嬮€斿緫锛�锛�
鎺屾彙鑵庡皬绠¤垏闆嗗悎绠￠噸鍚告敹 NaCl 鍜屾按銆侀噸鍚告敹 HCO3
-
鍜屽垎娉� H+
銆侀噸鍚告敹鑸囧垎娉� K+
銆侀噸鍚�
鏀惰垏鎺掓硠 Ca
2 +
銆侀噸鍚告敹钁¤悇绯栧拰姘ㄥ熀閰哥殑姗熷埗锛岃厧绯栭柧鑸囪憽钀勭硸閲嶅惛鏀舵サ闄愰噺鐨勬蹇碉紝 NH3
鐨勫垎娉岃垏 H
+
鍜� HCO3
-
杞�(zhu菐n)閬嬬殑闂�(gu膩n)绯�銆�
锛�5锛夌啛鎮夊翱娑叉績绺垏绋€閲嬬殑姒傚康銆佽厧楂撹唱(zh矛)婊查€忔搴﹀舰鎴愮殑姗熷埗銆佺洿灏忚绠″湪缍寔鑵庨珦
璩�(zh矛)婊查€忔搴︿腑鐨勪綔鐢�锛岀啛鎮夊翱娑叉績绺拰绋€閲嬬殑姗熷埗銆�
锛�6锛夌啛鎮夊皬绠℃恫涓憾璩�(zh矛)婵冨害灏嶈厧灏忕鑸囬泦鍚堢鍔熻兘鐨勫奖闊�銆佺悆绠″钩琛＄殑姒傚康銆佽厧浜ゆ劅
绁炵稉(j墨ng)鐨勪綔鐢�锛屾帉鎻℃姉鍒╁翱婵€绱犵殑浣滅敤鍙婂叾鍒嗘硨瑾�(di脿o)绡€(ji茅)銆佽厧绱�-琛€绠＄穵寮电礌-閱涘浐閰郴绲�(t菕ng)鐨勪綔鐢ㄥ強
鑵庣礌鍒嗘硨鐨勮(di脿o)绡€(ji茅)锛屼簡瑙ｅ績鎴块垑灏胯偨浠ュ強鍏跺畠婵€绱犵殑浣滅敤銆�
锛�7锛夌啛鎮夋竻闄ょ巼鐨勬蹇靛強瑷堢畻鏂规硶銆佹脯瀹氭竻闄ょ巼鐨勬剰缇╋紝浜嗚В鑶€鑳卞拰灏块亾鐨勭缍�(j墨ng)鏀厤銆�
鎺掑翱鐣板父锛屾帉鎻℃帓灏垮弽灏勬鍒�銆�
绗節绔� 绁炵稉(j墨ng)绯荤当(t菕ng)鐨勫姛鑳�
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鏁� 鏉愶細鏈卞ぇ骞� 鐜嬪涵妲� 涓荤法锛屻€婄敓鐞嗗銆嬬 8 鐗堬紝浜烘皯琛�(w猫i)鐢熷嚭鐗堢ぞ锛�2013 骞�
涓昏鍙冭€冩浉鐩細鏈卞ぇ骞� 涓荤法锛屻€婁汉楂旂敓鐞嗗銆嬬 7 鐗�锛屼汉姘戣(w猫i)鐢熷嚭鐗堢ぞ锛�2010 骞�
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Ganong WF.Review of Medical Physiology.20th ed,McGraw-Hill,2001
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