血液净化与常规治疗糖尿病乳酸性酸中毒临床疗效对比

目的比较血液净化连续静脉—静脉血液滤过(CVVH)和连续静脉—静脉血液滤过透析(CVVHDF)]及常规治疗在糖尿病乳酸性酸中毒治疗中的疗效。方法回顾性分析2008年8月—2011年11月沧州市中心医院收治的18例糖尿病乳酸性酸中毒患者的临床资料。血液净化组11例,分别为CVVH模式6例,CVVHDF模式5例,常规治疗组7例,观察分析两组患者治疗前后血乳酸、血pH值、肌酐、尿素氮的变化,患者的死亡率。结果两组患者血乳酸、肌酐、尿素氮下降,血pH值上升的速度差异有统计学意义(P0.05),血乳酸(mmol/L):CVVH(3.0±1.7)、CVVHDF(3.4±2.1)、常规治疗(7.0±2.8);血肌酐(μmol/L):CVVH(45±12)、CVVHDF(43±8)、常规治疗(82±28);尿素氮(mmol/L):CVVH(4.5±0.9)、CVVHDF(4.2±0.8)、常规治疗(8.4±2.9);pH:CVVH(7.45±0.05)、CVVHDF(7.43±0.02)、常规治疗(7.29±0.06)。血液净化组优于常规组;两组患者的死亡率差异有统计学意义(P0.05)。结论血液净化治疗能有效地清除糖尿病患者体内乳酸,纠正酸中毒,维持内环境稳定,改善患者预后,降低病死率。治疗效果优于常规治疗组。

Comparison of clinical effect between blood purification and routine treatment for lactic acidosis in diabetes patients

Objective] To compare the clinical effect between blood purificationcontinuous veno-venous hemofiltration（CVVH）/ continuous veno-venous hemofiltration dialysis（CVVHDF） ]and routine treatment for lactic acidosis in diabetes patients.Methods]The clinical data of 18 diabetes patients with lactic acidosis in Cangzhou Central Hospital from August 2008 to November 2011 were analyzed retrospectively.Among 11 patients in blood purification group,6 were treated by CVVH mode and 5 were treated by CVVHDF mode.There were 7 patients in the routine treatment group.The change of serum lactic acid,serum pH value,creatinine,urea nitrogen and mortality before and after treatment of two groups were observed.Results]There were significant differences in decreasing speed of serum lactic acid,creatinine and urea nitrogen,as well as rising speed of serum pH value between two groups（P0.05）.The level of serum lactic acid was as follows： CVVH（3.0±1.7） mmol/L,CVVHDF（3.4±2.1） mmol/L and the routine treatment group（7.0±2.8） mmol/L.The level of serum creatinine was as follows： CVVH（45±12） μmol/L,CVVHDF（43±8）μmol/L and the routine treatment group（82±28）μmol/L.The level of urea nitrogen was as follows： CVVH（4.5±0.9） mmol/L and CVVHDF（4.2±0.8） mmol/L and the routine treatment group（8.4±2.9） mmol/L.The level of pH value was as follows： CVVH（7.45±0.05）,CVVHDF（7.43±0.02） and the routine treatment group（7.29±0.06）.The clinical effect of the blood purification group was better than that of the routine treatment group,and there was significant difference in mortality between two groups（P0.05）.Conclusion]Blood purification can effectively remove the lactic acid in patients with diabetes,correct acidosis,maintain a stable internal environment,improve the outcomes,and reduce the mortality,which the clinical effect is better than that of the routine treatment group.