乳酸盐置换液在危重病人CRRT中的应用

目的：评价乳酸盐置换液在危重病1人CRRT治疗中的应用价值。方法：选择在ICU行cRRT治疗的．63例危重病人（乳酸盐置换液组34人．碳酸氧盐置换液组29人）．于治疗前、治疗24h和48h测定血乳酸、PH、BE、HCO3-、平均动脉压（MAP）等参数并进行比较。结果：乳酸盐组在CRRT治疗24h、48h后．乳酸呈下降趋势，但朱达到统计意义差别。碳酸氢盐组cRRT治疗24h后，乳酸即下降，至4BH乳酸较治疗前均达到显著意史差异（P〈0.05）。血PH值、BE和HC03-在CRRT治疗后24h、48h两组均显著升高，血清肌酐在治疗24h后两组均显著下降，A8h下降更为显著，而平均动脉压和钠离子在治疗过程中无统计意义差别。除乳酸、BE外,CRRT 486后靴酸盐组和碳酸氢盐组各时间点参数均无统计学差异。结论：氧酸盐置换液不升高血乳酸。在纠正酸中毒、维持血压、稳定内环境方面具有优势，乳酸盐置换液可以安全地用于危重病人的CRRT治疗。

Analysis the Value of Lactate Substitution Fluid for Continuous Renal Replacement Therapy in Critical Ill Patient

Objective： To investigate the value of lactate substitution fluid for continuous renal replacement therapy （CRRT） in critical ill patient. Methods： Sixty-three patients without severe hepatic failure and chronic renal failure in intensive care unit were treated with CRRT, thirty-four patient using lactate containing fluids but twenty-nine using bicarbonate-based fluids. Lactate, PH, base-exess, HCO（, mean arterial pressure （MAP） were measured before, after 24h and 48h CVVH. Results： The plasma lactate concentration was no statistically decreased after 24h and 48h CVVH in lactate group. Lactate was remarkably decreased after 24h and 48h CVVH in bicarbonate group （P〈0.05） .PH, base-excess and HCO~ were improved in both group. Serum creatinine fell significantly in both groups after 24h CVVH, even greater after 48h CVVH. However, there were no significant difference in mean arterial pressure and serum sodium during CVVH. Lactate and base-excess but not other parameters were greatly changed in lactate group compared with bicarbonate group. Conclusion： Lactate substitution fluid can maintain acid-base balance, pressure and homeostasis but not elevated lactate level .It can be safely used for CVVH in critical ill patients.