连续性高容量静-静脉血液滤过救治多种危重病症并发重症乳酸性酸中毒的临床应用

乳酸性酸中毒（Lactic acidosis，LA）系各种原因引起组织缺氧，丙酮酸未氧化时即还原为乳酸，或因肝肾等疾病乳酸清除障碍，导致大量乳酸在体内堆积，血内乳酸浓度升高所致。由于多病情危重，其死亡率极高，有人报道严重的乳酸性酸中毒死亡率约为50%。当血乳酸水平超过25mmol/L时，则罕见存活者，给患者家庭带来了巨大痛苦和沉重的经济负担。2011年1月—2012年6月我院重症监护病房收治60例多种危重病症并发重症乳酸性酸中毒患者，在基础治疗的同时，我们分别加用连续性高容量静-静脉血液滤过（HVCVVH）和血液透析，获得了较好疗效，现报道如下。

1临床资料

1.1一般资料多种危重病症并发重症乳酸性酸中毒患者60例，其中男33例，女27例，发病年龄33～68岁。其中糖尿病不规范服用双胍类药物27例，复合外伤致多脏器功能衰竭12例，产后大出血伴多脏器功能衰竭6例，感染性休克6例，肠梗阻术后致多脏器功能衰竭5例，重症急性胰腺炎伴休克4例。其中昏迷25例，行气管插管14例、机械通气（通气模式为IPPV、A/C、SIMV、PSV等）。将60例患者随即分为治疗组与对照组，每组各30例。

1.2治疗方法基础治疗包括对因治疗，补液、扩容，纠正水、电解质失衡，5%碳酸氢钠静脉滴注纠正酸中毒，胰岛素应用，输血、止血，营养支持，抗感染，应用血管活性药物和改善重要脏器功能药物等。在此治疗的基础上，治疗组加用连续性高容量静-静脉血液滤过，采用德国费森尤斯公司生产的CRRT机，

doi:10.3969/j.issn.1008-4118.2012.04.02

连续性高容量静-静脉血液滤过救治多种危重病症并发

重症乳酸性酸中毒的临床应用

李文耀，王金枝，魏艳丽，张玉国，宋美茹

（附属菏泽市立医院，山东菏泽274030）

摘要：目的探讨连续性高容量静-静脉血液滤过救治多种危重病症并发重症乳酸性酸中毒患者疗效。方法将60例患者随机分为治疗组30例和对照组30例。在基础治疗的同时，治疗组加用连续性高容量静-静脉血液滤过，对照组加用血液透析，监测两组患者治疗前后血清乳酸、pH值、血碳酸氢根、阴离子间隙等的变化。结果经连续性高容量静-静脉血液滤过和血液透析治疗，每组患者治疗前后及治疗后两组间监测指标等比较具有显著性差异。结论连续性高容量静-静脉血液滤过和血液透析治疗多种危重病症并发重症乳酸性酸中毒均有明显疗效，治疗组优于对照组。

关键词：连续性高容量静-静脉血液滤过/治疗应用；血液透析；乳酸性酸中毒/治疗

中图分类号：R459.5文献标识码：A文章编号：1008-4118（2012）04-0003-03

Continuous High-capacity Venous-venous Hemofiltration Cure a Variety of Critical Diseases

ComplicatedSevere Lactic Acidosis Clinical Application

Li Wenyao et al

(The Municipal Hospital Affiliated to Heze Medical College,Heze274030,Shandong) Abstract：Objective To Investigate continuous high-capacity venous-venous hemofiltration cure patients with a variety of critical disease complicated severe lactic acidosis.Methods60patients were randomly divided into the treatment group(30cases) and control group(30cases).In the basic treatment at the same time,the treatment group combined with continuous high-capacity ve⁃nous-venous hemofiltration,the control group combined with hemodialysis,monitoring change of the two groups before and after treatment in patients with serum lactic acid,PH value,blood carbonic acid hydrogen root,anion gap,and carries on statistics process⁃ing.Results Continuous high-capacity venous-venous hemofiltration and hemodialysis,after treatment in the two groups of patients before and after treatment and after treatment between two groups,monitoring indicators have improved obviously,statistical analysis is significant.Conclusion Continuous high-capacity venous-venous hemofiltration and hemodialysis in treatment of critical diseas⁃es complicated severe lactic acidosis have obvious curative effect,the treatment group was better than control group.

Key words：Continuous high-capacity venous-venous hemofiltration/therapeutic use；Hemodialysis；lactic acidosis/therapy

3