Objectives To study the role of the kidney in the maintenance of metabolic alkalosis of critically ill patients during perioperative period.Methods The patients who had metabolic alkalosis in the surgical intensive care unite（SICU） from Nov 2004 to Feb 2005 were enrolled in the alkalosis group；and the control group were the perioperative patients in the department of hepatic surgery at the same time，those who had acid-base imbalance were excluded.The enrolled patients underwent routine tests and some parameters such as creatinine clearance rate（Ccr，to evaluate glomerular filtration rate），titratible acid，ammonium ion，urinary bicarbonate，net acid excretion were calculated.Results The Ccr of the alkalosis group and control group was（76.2±37.1）mL/min vs（98.5±31.9）mL/min，respectively（P=0.042） with a decrement of 22% in the alkalosis group.The titratible acid was（25.2±19.4）mmol/24 h vs（49.9±26.4）mmol/24 h，respectively（P=0.002）；the net acid excretion was（156.5±84.3） mmol/24 h vs（117.5±32.1）mmol/24 h，respectively（P=0.047）；the ammonium ion was（140.6±81.6） mmol/24 h vs（78.7±16.3）mmol/24 h，respectively（P=0.002）.The postoperative electrolytes of the alkalosis group and control group：[K+] was（3.51±0.67）mmol/L vs（4.14±0.59）mmol/L，respectively（P=0.002）；[Cl－] was（98.4±8.3）mmol/L vs（102.8±3.0）mmol/L，respectively（P=0.035）；[Ca2+] was（2.14±0.21）mmol/L vs（2.25±0.14）mmol/L，respectively（P=0.049）；[P] was（0.83±0.34）mmol/L vs（1.11±0.23）mmol/L，respectively（P=0.004）；[Na+] was（139.6±7.7）mmol/L vs（140.8±4.6）mmol/L，respectively（P=0.535）；[Mg2+] was（0.94±0.15）mmol/L vs（0.90±0.16）mmol/L，respectively（P=0.338）.Conclusions Decreased glomerular filtration rate and enhanced renal acidification function are the important factors that maintain the metabolic alkalosis during perioperative period.Potassium，chloride，calcium and phosphorus are decreased during metabolic alkalosis，while sodium and magnesium has no significant change.
Objective To establish amedical reference for adult pulmonary function parameters and a normal FEV1 /FVC% pred in population of Shanghai. Methods Subjects who underwent routine physical examination were initially screened and those who met enrollment criteria with age over 18 years old were required to underwent pulmonary function tests in Zhongshan Hospital from June 2009 to February 2010. After screening of 450 subjects, a total of 240 subjects with normal pulmonary function and 120 subjects with mild small airway abnormalities were enrolled in this study according to the prediction equations established in1988. All subjects were assigned into 6 groups according to their age with30 males amd 30 females in each group. Pulmonary function parameters including VC, FVC, FEV1 , FEV1 /FVC, PEF, FEF25% , FEF50% , FEF75% , RV, FRC, TLC, RV /TLC, DLCO, and KCO were collected for analysis. New prediction equations for the above 14 parameters were established by parameters of anthropometry. The medical reference ranges of 14 parameters were calculated according to the newprediction equations. The normal FEV1 /FVC%pred was also calculated. Results New prediction equations for normal adult pulmonary function parameters in Shanghai were established. DLCO =5.206 +4. 314 ×gender ( “male”= 1, “female”=0) - 0. 144 ×age( y) +0. 098 × height( cm) +0. 082 ×weight( kg) , KCO =9. 346 - 0. 026 ×age( y) - 0. 031 ×height( cm) +0. 025 ×weight( kg) .The LLN( P5) of VC, FVC, FEV1 , FEV1 /FVC, the LLN( P2. 5 ) and the upper limit of normal value ( P97. 5) of FRC, TLC, RV, RV/TLC were calculated. The LLN( P5) of FEV1 /FVC = 101. 924 - 0. 144 × age ( y) - 0. 118 ×high( cm) . The lower normal limit of FEV1 /FVC% pred was 92% . Conclusions This is the first time to have the medical reference of FEV1 /FVC% pred in China, and new prediction equations for DLCO in Shanghai. The LLN of FEV1 /FVC or FEV1 /FVC% pred lt;92% can be used as diagnostic criteria for obstructive ventilation disorder. Instead of using FEV1% pred lt; 80% , FEV1 lt; LLN can be used as diagnostic criteria for mild ventilation disorder.