簡単に理解できる酸塩基平衡～看護師のブログ～
酸塩基平衡～重炭酸緩衝系について～
本日は酸塩基平衡について書きます。血液ガスを勉強すると必ず出てくるのが酸塩基平衡です。
血液ガスの中でも酸塩基平衡は苦手だと思ってみえるかたは多いと思います。そもそも酸塩基平衡という名前が難しいですよね…
今日は酸塩基平衡を簡単に理解する方法をお話します。
pH（水素イオン濃度）について
酸塩基平衡を理解するために最初に覚えることがあります。それは血液のpH（ペーハーといいます）です。pHとは、液体が酸性なのかアルカリ性なのかを表すものです。ちなみにpH7.0を中性といいます。7.0より数字が少ないと酸性、多いとアルカリ性になります。
シャンプーや、洗剤などでもpHが使われています。例えば弱酸性シャンプーとか、中性洗剤とか。血液の正常なpHは7.35～7.45で少しアルカリ性です。この狭い範囲で常に調整されています。ちなみに細胞の中はpH7.0の中性です。
血液のpHを7.35～7.45という狭い範囲で調整しているのは、血液がこのpHを保っていないと、正常な代謝が行われないためです。例えば、pHが低くなると（酸性）心臓の動きが悪くなるなど、生命の維持に関わるような重大な事態につながります。
では、血液のpHは何で決まるのかということですが、pHは血液内のH+（水素イオン）というものの量で決まります。水素イオンは、常に体の中で発生しています。この水素イオンの量を調整することで、血液のpHが決まります。人間は水素イオンを体外へ排泄したり、水素イオンを体の中で、他のものに変えることによってpHを常に調整しています。
ちなみにH+（水素イオン）が増えれば血液は酸性になります（PHは下がります）反対にH+（水素イオン）が減れば血液はアルカリ性になります。
酸と塩基の簡単な覚え方
次に酸と塩基について説明します。酸と塩基はものすごく奥が深いので、詳しく知ろうと思うと、科学の勉強が必要になります…。
血液ガスでの酸と塩基を覚えるには「酸とはH+（水素イオン）を放出するもの。塩基とはH+（水素イオン）を受け取るもの」と覚えるのが一番よいと思います。つまり、酸はH+を放出するものなので、酸が増えれはH+（水素イオン）が増えるのでpHは酸性となります。逆に塩基が増えれば、H+（水素イオン）を受け取る（中和すると覚えるといいです）のでH+（水素イオン）が減って血液はアルカリ性になります。
酸が増える⇒H+（水素イオン）が増える＝ｐHは下がる（酸性）
塩基が増える⇒H+（水素イオン）が減る＝pHは上がる（アルカリ性）
このシンプルな覚え方がよいと思います。
重炭酸緩衝系
次に重炭酸緩衝系について説明します。体の中でH+（水素イオン）を調整してpHを調整しているとお話しましたが、具体的にはどのように調整が行われているのか？その調整機能を担っているもので重要なのが重炭酸緩衝系です。ちなみに、緩衝（かんしょう）と読みます。重炭酸緩衝系とは体の中でH+（水素イオン）の量を調整する機能のことです。
重炭酸緩衝系を覚えるのは式がありますので解説します↓
Paco2+H2O ⇔ H２Co3 ⇔ H++HCO３－
式をみて、嫌になった方もみえると思いますが、わかりやすく解説します。
Paco2（血液中の二酸化炭素）+H2O（水） ⇔ H２Co3（炭酸水） ⇔ H+（水素イオン）+HCO３－（重炭酸）⇔は姿を変えると考えてください。
二酸化炭素+水 ⇔ 炭酸 ⇔ 水素イオン+重炭酸
まず、二酸化炭素と水は反応して炭酸になります。これはイメージしやすいですよね。これがPaCO2+H2O ⇔ H２Co3 の部分です。次に、H+（水素イオン）にHCO３－（重炭酸）を足すと同じく炭酸になります。これがH２Co3 ⇔ H++HCO３－の部分です。（実際には炭酸脱水素酵素というものが働いて変化が起こります。）
二酸化炭素は細胞が代謝を行い、体の中でどんどん発生されています。発生した二酸化炭素は式からわかるように、血液の中で炭酸や重炭酸に姿を変えます。
二酸化炭素+水 ⇔ 炭酸 ⇔ 水素イオン+重炭酸
体内にある○○酸という物質は全てH+（水素イオン）を放つ酸です。
炭酸は酸ですが、そもそも炭酸を発生させているものは二酸化炭素（水と反応して炭酸になっている）です。
酸塩基平衡は、二酸化炭素と重炭酸というものがキーポイントです。
二酸化炭素自体が減れば、酸（水素イオンを放つもの）が減るので血液はアルカリ性になります。逆に二酸化炭素が増えれば酸が増えるので血液は酸性になります。重炭酸が増えれば、水素イオンが減るので、血液はアルカリ性になります。逆に重炭酸が減れば水素イオンが増えるので血液は酸性になります。
二酸化炭素の調整は、肺（呼吸）。重炭酸の調整は腎臓で行われています。ちなみに重炭酸は腎臓で排泄されるか、再吸収されるかで調整されます。
つまり、二酸化炭素と重炭酸の量を調整して血液のpHを調整しているのです。
重炭酸を点滴するとなぜ血液のpHが変わる？
重炭酸は、体が酸性になった人に点滴で投与されることがあります。重炭酸を投与すると血液のpHはアルカリの方向へと変動します。これはなぜなのか？これは重炭酸緩衝系の式で説明ができます。
二酸化炭素+水 ⇔ 炭酸 ⇔ 水素イオン+重炭酸
重炭酸を点滴すると、血液の水素イオンと反応して炭酸となります。炭酸には二酸化炭素が含まれています。この二酸化炭素は肺に行くと肺胞へ移動して、呼吸で排泄されます。つまり、重炭酸を投与すると、二酸化炭素が増加して、増加した二酸化炭素が呼吸で排泄されるために、酸が減る⇒ｐHはアルカリ方向に進むことになるためです。
ここでの注意点は、重炭酸の投与は二酸化炭素が増えること＝呼吸に負担をかけることになります。つまり、二酸化炭素が何かの原因で増えている人に重炭酸を投与すると、さらに二酸化炭素を増やしてしまうことになります。これは毒をもっているに等しいです。
pHが変動するのは呼吸性と代謝性がある
二酸化炭素と重炭酸が血液のpHを調整しています。厳密に言えばこの他にも、体内で発生した酸は（不揮発性酸）腎臓で排泄されていますが、細胞呼吸から発生する二酸化炭素（揮発性酸）が酸の大部分です。
二酸化炭素が増えたり減ったりすることでpHが変動するのを呼吸性。重炭酸が増えたり減ったりすることでpHが変動するのを代謝性といいます。
例えば呼吸が浅くて、二酸化炭素が排泄できない⇒血液中の二酸化炭素が増加する⇒血液が酸性になる。この状態を呼吸性アシドーシスといいます。アシドーシスとは血液が酸性になっていく過程や病態のことをいいます。反対に血液がアルカリ性になっていく過程や病態をアルカローシスといいます。
腎臓が障害されて、重炭酸が再吸収されない、または不揮発性酸が排泄されない等⇒水素イオンが増える⇒血液が酸性になる。この状態を代謝性アシドーシスといいます。この状態になる疾患は尿細管性アシドーシスなどがあります。
その他、水素イオンを放つ酸が体内で増える代謝性アシドーシスもあります。乳酸やアセト酢酸，β-
まとめ
・血液のpHは水素イオン濃度（量）で決まる。水素イオンが多いと酸性、少ないとアルカリ性になる。
・水素イオンを放つものを酸、水素イオンを受け取るものを塩基と呼ぶ
・血液のpHを調整する重要なものが重炭酸緩衝系
・二酸化炭素と重炭酸の量を調整して血液のpHを調整している
・二酸化炭素は呼吸で、重炭酸は腎臓で調整している
・pHが変動するものには、呼吸性と代謝性がある
・酸塩基平衡は血液ガス値のpHとPaCO2とHCO3－を見る
☆最後までお読みいただきありがとうございます☆
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