Аннотация

Резюме

To study the acid-base balance (ABB) indices in various vascular beds and the buffering activity of the lungs in sepsis against the background of organ dysfunctions depending on the dominant organ damage and the severity of the condition.

Материал и методы

The article presents the results of comprehensive diagnostics and treatment of 100 patients with sepsis and organ and systemic dysfunctions, including group 1 (40 patients) with predominant acute kidney injury (AKI), group 2 (30 patients) with leading manifestations of acute liver failure (ALF), group 3 (30 patients) with dominant course of acute respiratory distress syndrome (ARDS), conditionally divided into subgroups depending on the functional state of metabolic functions of the lungs (MFL) (compensation, sub- and decompensation), and a control group of 30 practically healthy donors (PHD). pH, HCO3- and BE were studied from various vascular accesses (venous cubital blood, mixed venous blood and arterial blood), a comparative analysis of these parameters in arterial and mixed venous blood was performed.

Результаты

Blood acid-base balance values, taken from various vascular beds, significantly differed depending on the stage of metabolic dysfunction. Gradual changes were observed, from compensated to decompensated metabolic acidosis. The lungs demonstrated an active buffering function, facilitating the correction of acid-base imbalances; however, the effectiveness of this mechanism decreased as the functional state of the metabolic dysfunction worsened.

Заключение

In case of organ dysfunctions against the background of sepsis, correction of acidosis with sodium bicarbonate should be carried out only taking into account the data of the B-A difference in pH, HCO3- and BE indicators of arterial blood.

Ключевые слова

lung buffering function metabolic lung function acid-base balance metabolic acidosis metabolic alkalosis blood buffering system lungs organ dysfunction postpartum complications

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Список литературы

  1. Shokirov TM, Muradov AM. Bufernaya aktivnost lyogkikh, ikh vliyanie na kislotno-osnovnoe sostoyanie i elektrolity krovi u bolnykh terminalnoy stadiey khronicheskoy bolezni pochek, oslozhnennoy serdechnoy nedostatochnostyu [Buffer activity of the lungs and its influence on acid-base balance and blood electrolytes in patients with end-stage chronic kidney disease complicated by heart failure]. Vestnik Akademii Med Nauk Tadzhikistana – Medical Bulletin of the National Academy of Sciences of Tajikistan. 2019; 9(3): 308–313. DOI: 10.31712/2221-7355-2019-9-3-308-313 (In Russ.)
  2. Komilov TT, Muradov AM, Muradov AA, Fayzuloev KhT, Shumilina MV. Kharakteristika funktsionalnykh pokazateley pochek u bolnykh infarktom miokarda v zavisimosti ot stadii ostrogo pochechnogo povrezhdeniya [Characteristics of renal functional parameters in patients with myocardial infarction depending on the stage of acute kidney injury]. Vestnik poslediplomnogo obrazovaniya v sfere zdravookhraneniya – Bulletin of Postgraduate Education in Healthcare. 2021; (4): 56–63. (In Russ.)
  3. Li X, Yuan F, Zhou L. Organ crosstalk in acute kidney injury: evidence and mechanisms. J Clin Med. 2022; 11(22): 6637. DOI: 10.3390/jcm11226637
  4. Rojas-Suarez J, Vanegas I, Lavalle O, et al. Acid-base imbalances in critically ill obstetric patients: multicentre retrospective cohort study. Aust Crit Care. 2025; 38(5): 101297. DOI: 10.1016/j.aucc.2025.101297
  5. Bakina AA, Pavlenko VI. Kompleksnyy analiz kislotno-osnovnogo statusa, gazovogo i elektrolitnogo sostava venoznoy krovi u bolnykh khronicheskoy obstruktivnoy boleznyu legkikh razlichnykh kategoriy riska obostreniy [Comprehensive analysis of acid-base status, blood gases and electrolytes in patients with chronic obstructive pulmonary disease of different exacerbation risk categories]. Vestnik sovremennoy klinicheskoy meditsiny – The Bulletin of Contemporary Clinical Medicine. 2020; 13(1): 10–16. DOI: 10.20969/VSKM (In Russ.)
  6. Shumilina OV. Legkie v sisteme detoksikatsii pri peritonite (obzor literatury) [Lungs in the detoxification system in peritonitis (literature review)]. Biologiya i integrativnaya meditsina – Biology and Integrative Medicine. 2023; 5(64): 106–123. (In Russ.)
  7. Fayzulloev KhT. Bufernaya aktivnost lyogkikh i ikh vliyanie na elektrolity, kislotno-osnovnoe sostoyanie i osmolyarnost krovi u bolnykh pri sochetannykh infarkte miokarda i ishemicheskom insulte [Buffer activity of the lungs and its influence on electrolytes, acid-base balance and blood osmolarity in patients with combined myocardial infarction and ischemic stroke]. Vestnik Akademii Med Nauk Tadzhikistana – Medical Bulletin of the National Academy of Sciences of Tajikistan. 2022; 12(1): 52–60. (In Russ.)
  8. Mazurok VA, Antonova IV, Golovkin AS, et al. Enteropatii kriticheskikh sostoyaniy: klinikomorfologicheskie obrazy, vozmozhnosti korrektsii [Enteropathy of critical conditions: clinical and morphological patterns and correction possibilities]. Translyatsionnaya meditsina – Translational Medicine. 2016; 3(5): 42–52. (In Russ.)
  9. Dustov ShB, Muradov AM, Shumilina OV. Pokazateli vodnogo obmena i osmolyarnosti krovi u bolnykh s ostroy dekompensatsiey khronicheskoy serdechnoy nedostatochnosti do i posle lecheniya [Indicators of water metabolism and blood osmolarity in patients with acute decompensation of chronic heart failure before and after treatment]. Vestnik Akademii Med Nauk Tadzhikistana – Medical Bulletin of the National Academy of Sciences of Tajikistan. 2021; 11(4): 13–19. (In Russ.)
  10. Muradov AM. Sindrom narusheniy nerespiratornykh funktsiy lyogkikh [Syndrome of disorders of non-respiratory lung functions]. Dushanbe: Suman; 2000. 283 p. (In Russ.)
  11. Urakova MA. Nerespiratornye funktsii legkikh pri eksperimentalnom vnutrimozgovom krovoizliyanii v usloviyakh vvedeniya fingolimoda [Non-respiratory functions of lungs in experimental intracerebral hemorrhage during fingolimod administration]. Regionarnoe krovoobrashchenie i mikrotsirkulyatsiya – Regional Blood Circulation and Microcirculation. 2021; 20(4): 70–74. DOI: 10.24884/1682-6655-2021-20-4-70-74 (In Russ.)
  12. Achanti A, Szerlip HM. Acid-base disorders in the critically ill patient. Clin J Am Soc Nephrol. 2023; 18(1): 102–112. DOI: 10.2215/CJN.04500422
  13. Kulikov AV, Shifman EM, Protsenko DN, et al. Septicheskiy shok v akusherstve: klinicheskie rekomendatsii Obshcherossiyskoy obshchestvennoy organizatsii «Federatsiya anesteziologov i reanimatologov» [Septic shock in obstetrics: clinical guidelines of the Federation of Anesthesiologists and Reanimatologists of Russia]. Vestnik intensivnoy terapii imeni A.I. Saltanova – Annals of Critical Care. 2023; (2): 7–44. DOI: 10.21320/1818-474X-2023-2-7-44 (In Russ.)
  14. Yaroshetskiy AI, Gritsan AI, Avdeev SN, et al. Ostryy respiratornyy distress-sindrom (u vzroslykh patsientov). Klinicheskie rekomendatsii (peresmotr 2025 g.) [Acute respiratory distress syndrome (in adults): clinical guidelines (revision 2025)]. Vestnik intensivnoy terapii imeni A.I. Saltanova – Annals of Critical Care. 2025; (4): 7–68. DOI: 10.21320/1818-474X-2025-4-7-68 (In Russ.)
  15. Chong WH, Saha BK, Medarov BI. Comparing central venous blood gas to arterial blood gas and determining its utility in critically ill patients: narrative review. Anesth Analg. 2021; 133(2): 374–378. DOI: 10.1213/ANE.0000000000005501
  16. Sanghavi SF, Swenson ER. Arterial blood gases and acid-base regulation. Semin Respir Crit Care Med. 2023; 44(5): 612–626. DOI: 10.1055/s-0043-1770341
  17. Chen L, Grieco DL, Beloncle F, et al. Correction: partition of respiratory mechanics in patients with acute respiratory distress syndrome and association with outcome: multicentre clinical study. Intensive Care Med. 2023; 49(3): 386. DOI: 10.1007/s00134-023-06985-1
  18. Szrama J, Smuszkiewicz P, Trojanowska I. Acid-base disorders according to the Stewart approach in septic patients. Crit Care. 2014; 18(Suppl 1): 429. DOI: 10.1186/cc13619
  19. Thille AW, Peñuelas O, Lorente JA, et al. Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: retrospective autopsy analysis. Crit Care. 2017; 21(1): 254. DOI: 10.1186/s13054-017-1852-5
  20. Machado F, Guarnieri A, Freitas FG, et al. Prognostic value of central venous-arterial pCO2 difference in severe sepsis and septic shock. Crit Care. 2010; 14(Suppl 1): 155. DOI: 10.1186/cc8387
  21. Lumholdt M, Andreasen JB, Damgaard K, et al. Comparison of venous and calculated blood gas values to arterial values in critically ill patients. Acta Anaesthesiol Scand. 2025; 69(1): e14555. DOI: 10.1111/aas.14555
  22. Kashlan OB, Wang XP, Sheng S, Kleyman TR. Epithelial Na+ channels function as extracellular sensors. Compr Physiol. 2024; 14(2): 1–41. DOI: 10.1002/cphy.c230015
  23. Giani D, Santoro MC, Gabrielli M, et al. The role of venous blood gas analysis in critical care: narrative review. Medicina (Kaunas). 2025; 61(8): 1337. DOI: 10.3390/medicina61081337
  24. White HD, Vazquez-Sandoval A, Quiroga PF, et al. Utility of venous blood gases in severe sepsis and septic shock. Proc (Bayl Univ Med Cent). 2018; 31(3): 269–275. DOI: 10.1080/08998280.2018.1460133